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GISSI-HF Omega-3 Trial — EECC MCQ

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ModerateHeart FailureGISSI-HF Omega-3 TrialEECC

A 62-year-old man with HFrEF and recent ACS asks about the role of omega-3 fatty acids in HF. What did the GISSI-HF trial demonstrate?

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Correct answer: C — GISSI-HF showed a small but statistically significant reduction in mortality and HF hospitalisations with n-3 PUFA (1 g daily) in HFrEF — it is the basis for a weak recommendation in some guidelines, though the absolute benefit is modest

The GISSI-HF trial (2008) randomised 6,975 HFrEF patients to n-3 PUFA (1 g daily, containing EPA+DHA) vs placebo. It showed a small but significant reduction in the co-primary endpoints: 9% relative reduction in death/CV hospitalisation and 8% reduction in death/CV hospitalisation. The absolute benefit was modest (NNT ~56 over 3.9 years). Rosuvastatin (tested in the same trial) showed no benefit in HFrEF. The ESC HF Guidelines include n-3 PUFA as a Class IIb recommendation based on this single trial. The modest effect size and subsequent mixed evidence from other omega-3 trials (STRENGTH, VITAL) have limited enthusiasm. Importantly, this is different from icosapent ethyl (purified EPA), which showed robust CV benefit in REDUCE-IT for hypertriglyceridaemia.

Reference: ESC (2023): HF Guidelines; GISSI-HF Trial