Randomized clinical trials (RCTs) with “hard” end points and meta-analyses of these trials should influence clinical practice because they represent the highest level of evidence. Health care behaviors based on less robust evidence are often established before such RCTs are conducted. If the results of high-quality RCTs contradict established practice, numerous barriers exist to their acceptance and implementation.1 ω-3 Fatty acid (FA) supplements are commonly used for the management of cardiovascular, neurocognitive, ophthalmic, and inflammatory disorders. In 2002, their use in the secondary prevention of heart disease was endorsed by the American Heart Association.2 Recently, their health effects have been studied in several RCTs and meta-analyses, many of which were reported in high-impact journals. Here, we report the relationship between these publications in influential journals and the use of ω-3 FAs.
Data are in millions of US dollars. Arrows indicate dates of publication of randomized clinical trials (solid arrows) or meta-analyses of randomized clinical trials (dashed arrows) of ω-3 FAs in high-impact medical journals between January 1, 2005, and December 31, 2012. Trials and meta-analyses with cardiovascular disease (CVD) end points are shown in the lower panel, and those with non-CVD end points are shown in the upper panel. a indicates the trials reporting a benefit of ω-3 FAs; NA, not available.
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