Effects of essential fatty acids on mild to moderate essential hypertension

Omega 6 fatty acids for the primary prevention of cardiovascular disease

BACKGROUND

Omega 6 plays a vital role in many physiological functions but there is controversy concerning its effect on cardiovascular disease (CVD) risk. There is conflicting evidence whether increasing or decreasing omega 6 intake results in beneficial effects.

OBJECTIVES

The two primary objectives of this Cochrane review were to determine the effectiveness of:1. Increasing omega 6 (Linoleic acid (LA), Gamma-linolenic acid (GLA), Dihomo-gamma-linolenic acid (DGLA), Arachidonic acid (AA), or any combination) intake in place of saturated or monounsaturated fats or carbohydrates for the primary prevention of CVD.2. Decreasing omega 6 (LA, GLA, DGLA, AA, or any combination) intake in place of carbohydrates or protein (or both) for the primary prevention of CVD.

SEARCH METHODS

We searched the following electronic databases up to 23 September 2014: the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library (Issue 8 of 12, 2014); MEDLINE (Ovid) (1946 to September week 2, 2014); EMBASE Classic and EMBASE (Ovid) (1947 to September 2014); Web of Science Core Collection (Thomson Reuters) (1990 to September 2014); Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database, and Health Economics Evaluations Database on the Cochrane Library (Issue 3 of 4, 2014). We searched trial registers and reference lists of reviews for further studies. We applied no language restrictions.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of interventions stating an intention to increase or decrease omega 6 fatty acids, lasting at least six months, and including healthy adults or adults at high risk of CVD. The comparison group was given no advice, no supplementation, a placebo, a control diet, or continued with their usual diet. The outcomes of interest were CVD clinical events (all-cause mortality, cardiovascular mortality, non-fatal end points) and CVD risk factors (changes in blood pressure, changes in blood lipids, occurrence of type 2 diabetes). We excluded trials involving exercise or multifactorial interventions to avoid confounding.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, extracted the data, and assessed the risk of bias in the included trials.

MAIN RESULTS

We included four RCTs (five papers) that randomised 660 participants. No ongoing trials were identified. All included trials had at least one domain with an unclear risk of bias. There were no RCTs of omega 6 intake reporting CVD clinical events. Three trials investigated the effect of increased omega 6 intake on lipid levels (total cholesterol, low density lipoprotein (LDL-cholesterol), and high density lipoprotein (HDL-cholesterol)), two trials reported triglycerides, and two trials reported blood pressure (diastolic and systolic blood pressure). Two trials, one with two relevant intervention arms, investigated the effect of decreased omega 6 intake on blood pressure parameters and lipid levels (total cholesterol, LDL-cholesterol, and HDL-cholesterol) and one trial reported triglycerides. Our analyses found no statistically significant effects of either increased or decreased omega 6 intake on CVD risk factors.Two studies were supported by funding from the UK Food Standards Agency and Medical Research Council. One study was supported by Lipid Nutrition, a commercial company in the Netherlands and the Dutch Ministry of Economic Affairs. The final study was supported by grants from the Finnish Food Research Foundation, Finnish Heart Research Foundation, Aarne and Aili Turnen Foundation, and the Research Council for Health, Academy of Finland.

AUTHORS' CONCLUSIONS

We found no studies examining the effects of either increased or decreased omega 6 on our primary outcome CVD clinical endpoints and insufficient evidence to show an effect of increased or decreased omega 6 intake on CVD risk factors such as blood lipids and blood pressure. Very few trials were identified with a relatively small number of participants randomised. There is a need for larger well conducted RCTs assessing cardiovascular events as well as cardiovascular risk factors.

Fasting serum free fatty acid composition, waist/hip ratio and insulin activity in essential hypertensive patients

Abnormal fatty acid metabolism may play an important role in the pathogenesis of essential hypertension (EH). We compared fasting serum free fatty acid (FFA) composition between EH patients and nonhypertensive (NH) subjects, and examined the relationships between fasting serum FFA composition and waist/hip ratio, insulin activity, blood pressure, serum zinc, age, and sex in both groups. We conducted a cross-sectional study of 232 community-dwelling subjects aged between 35 and 60 years: 109 EH patients and 123 NH subjects. Serum FFA was determined by HPLC analysis. The data were analyzed by multivariate linear stepwise regression, stratified analysis, and correlation analysis. In men, EH patients had lower C22:6/C20:5 ratios (n-3 Delta6-desaturase activity index, 7.96+/-8.81 vs. 14.5+/-13.1, p<0.01), polyunsaturated fatty acid (PUFA), n-3 PUFA and polyunsaturated/saturated (P/S) ratios compared with male subjects without hypertension. There were no differences in women. Fasting serum FFA composition was significantly related to many variables, including waist/hip ratio, insulin sensitivity index, and serum zinc (all p<0.05 or <0.01) for all the subjects, and included both age- and sex-related differences (both p<0.05). Compared with NH, EH patients had lower levels of serum zinc (14.9+/-5.00 micromol L(-1) vs. 16.8+/-6.38 micromol L(-1), p<0.05). We concluded that EH patients had marked alteration in fasting serum FFA composition, which was affected by upper body obesity, insulin resistance, zinc deficiency, and high dietary fat, and that the differences were age- and sex-related.

Antihypertensive effect and safety of dietary alpha-linolenic acid in subjects with high-normal blood pressure and mild hypertension

We investigated the antihypertensive effect and safety of alpha-linolenic acid (ALA) in human subjects. In Experiment 1, subjects with high-normal blood pressure and mild hypertension ingested bread containing 14 g of common blended oil (control oil) or ALA-enriched oil for 12 weeks. The test oil contained 2.6g/14 g of ALA. The subjects ingested strictly controlled meals during the study period. Systolic blood pressure was significantly lower in the ALA group than in the control group after ingestion of the test diet for 4, 8 and 12 weeks. Diastolic blood pressure was significantly lower in the ALA group than in the control group after ingestion of the test diet for 12 weeks. In Experiment 2, we evaluated the safety of high intake of ALA (7.8 g/d), particularly its effects on oxidation in the body and blood coagulation. Normotensive, high-normotensive and mildly hypertensive subjects ate bread that contained 42 g of the control oil or the test oil for 4 weeks. No significant difference was noted in the lipid peroxide level, high-sensitive C-reactive protein level, plasma prothrombin time or activated partial thromboplastin time between the two groups. No abnormal changes were noted after test diet ingestion on blood test or urinalysis, and no adverse event considered to have been induced by the test oil was observed in Experiment 1 and 2. These results suggest that ALA have an antihypertensive effect with no adverse effect in subjects with high-normal blood pressure and mild hypertension.

The cumulative dose response effect of eicosapentaenoic and docosahexaenoic acid on blood pressure, plasma lipid profile and diet pattern in mild to moderate essential hypertensive black patients

In this study eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were given in a cumulative manner, every 6 weeks, starting with 10 mg, then 100 mg, 1000 mg and 10,000 mg EPA daily to mild to moderate essential hypertensive black patients. The corresponding DHA doses were 3, 33, 333 and 3333 mg. A control group was given olive oil as placebo for the entire 24 weeks. The placebo group had lower diastolic and systolic blood pressures after 24 weeks than the EPA and DHA group. No effect was seen on plasma triglycerides, cholesterol, HDL-cholesterol and gamma-glutamyltranspeptidase at any stage of the trial. In the EPA group plasma free-EPA increased significantly from 1000 mg onwards and plasma free-arachidonic acid (AA) decreased after 1000 mg EPA. No other plasma free essential fatty acid changed during the trial, although the HDL:cholesterol increased slightly but non-significantly with an increase in EPA and DHA. No significant changes in diet pattern or body mass was observed. It is therefore concluded that EPA and DHA supplementation had no beneficial effects in mild to moderate essential hypertensive black patients except for a lowering of plasma AA.