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Ahmadi M, Askari VR, Shahri B, Mousavi Noghab SM, Jarahi L, Baradaran Rahimi V. Omega-3 fatty acids effectively mitigate high-sensitivity C-reactive protein (hs-CRP) biomarker of inflammation in acute myocardial infarction patients: a randomized, double-blind, placebo-controlled clinical trial. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03330-1. [PMID: 39073419 DOI: 10.1007/s00210-024-03330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
Myocardial infarction (MI) is considered an inflammatory disease and among the leading causes of death globally. An essential indicator of inflammation, high-sensitivity C-reactive protein (hs-CRP), is linked with the acute MI prognosis. We aimed to examine the impact of omega-3 polyunsaturated fatty acids (PUFAs) as an anti-inflammatory supplement on hs-CRP levels in acute MI patients. Sixty patients with acute MI participated in this randomized, placebo-controlled trial. For 30 days, patients were randomized to receive omega-3 PUFAs (2 g/day, N = 30) or placebo (N = 30) on top of guideline-directed medical therapy. An initial and endpoint measurement of hs-CRP was performed. We found that the hs-CRP levels in both omega-3 PUFAs and placebo groups remarkably decreased following 30 days of treatment (decreasing from 1.84 (2.3) and 1.3 (2.6) to 0.38 (0.54) and 0.63 (1.12) mg/dL, respectively; P < 0.001). Following the 30 days of treatment, the reducing impact of omega-3 PUFAs (↓ 1.54 (1.98) mg/dL) on hs-CRP was more robust than the placebo group (↓ 0.92 (1.57) mg/dL, P = 0.008). Furthermore, the WBC, cholesterol, LDL, and triglyceride levels were markedly decreased in omega-3 and placebo groups after 30 days of therapy (P < 0.001 for all). However, no remarkable differences were reported in the level of these parameters after 30 days of therapy between both studied groups. Our findings showed that omega-3 PUFAs decrease hs-CRP amounts in patients with acute MI. Omega-3 PUFA supplementation may be an appropriate candidate in patients with early-stage acute MI for inhibiting inflammation.
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Affiliation(s)
- Mostafa Ahmadi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Reza Askari
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahram Shahri
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdiar Mousavi Noghab
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lida Jarahi
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Bernhard B, Heydari B, Abdullah S, Francis SA, Lumish H, Wang W, Jerosch-Herold M, Harris WS, Kwong RY. Effect of six month's treatment with omega-3 acid ethyl esters on long-term outcomes after acute myocardial infarction: The OMEGA-REMODEL randomized clinical trial. Int J Cardiol 2024; 399:131698. [PMID: 38184150 DOI: 10.1016/j.ijcard.2023.131698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/15/2023] [Accepted: 12/29/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Omega-3 polyunsaturated fatty acids (O3-FA) have been shown to reduce inflammation and adverse cardiac remodeling after acute myocardial infarction (AMI). However, the impact of O3-FA on long-term clinical outcomes remains uncertain. AIMS To investigate the impact of O3-FA on adverse cardiac events in long-term follow up post AMI in a pilot-study. METHODS Consecutive patients with AMI were randomized 1:1 to receive 6 months of O3-FA (4 g/daily) or placebo in the prospective, multicenter OMEGA-REMODEL trial. Primary endpoint was a composite of major adverse cardiovascular events (MACE) encompassing all-cause death, heart failure hospitalizations, recurrent acute coronary syndrome, and late coronary artery bypass graft (CABG). RESULTS A total of 358 patients (62.8% male; 48.1 ± 16.1 years) were followed for a median of 6.6 (IQR: 5.0-9.1) years. Among those receiving O3-FA (n = 180), MACE occurred in 65 (36.1%) compared to 62 (34.8%) of 178 assigned to placebo. By intention-to-treat analysis, O3-FA treatment assignment did not reduce MACE (HR = 1.014; 95%CI = 0.716-1.436; p = 0.938), or its individual components. However, patients with a positive response to O3-FA treatment (n = 43), defined as an increase in the red blood cell omega-3 index (O3I) ≥5% after 6 months of treatment, had lower annualized MACE rates compared to those without (2.9% (95%CI = 1.2-5.1) vs 7.1% (95%CI = 5.7-8.9); p = 0.001). This treatment benefit persisted after adjustment for baseline characteristics (HRadjusted = 0.460; 95%CI = 0.218-0.970; p = 0.041). CONCLUSION In long-term follow-up of the OMEGA-REMODEL randomized trial, O3-FA did not reduce MACE after AMI by intention to treat principle, however, patients who achieved a ≥ 5% increase of O3I subsequent to treatment had favorable outcomes.
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Affiliation(s)
- Benedikt Bernhard
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Bobak Heydari
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Stephenson Cardiac Imaging Center, University of Calgary, Calgary, Alberta, Canada
| | - Shuaib Abdullah
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; VA North Texas Medical Center and University of Texas-Southwestern Medical School, Dallas, TX, USA
| | - Sanjeev A Francis
- Department of Cardiovascular Medicine, Maine Medical Center, Portland, USA
| | - Heidi Lumish
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Wei Wang
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Jerosch-Herold
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - William S Harris
- Fatty Acid Research Institute, Sioux Falls, SD 57106, USA; Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Chao T, Sun J, Ge Y, Wang C. Effect of omega-3 fatty acids supplementation on the prognosis of coronary artery disease: A meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2024; 34:537-547. [PMID: 38161115 DOI: 10.1016/j.numecd.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
AIMS To evaluate whether omega-3 fatty acids (ɷ-3 FAs) supplementation can improve cardiovascular outcomes in patients with established coronary artery disease (CAD). DATA SYNTHESIS Five electronic databases were searched for randomized controlled trials that evaluated the effect of ɷ-3 FAs on cardiovascular outcomes in patients with CAD. The language was restricted to English. The risk ratio was pooled. Subgroup analyses were conducted to evaluate whether study-level variables might act as effect modifiers. A total of 12 studies involving 29913 patients were included. ɷ-3 FAs had no effects on major adverse cardiovascular events (MACEs) (RR, 0.93; 95 % CI: 0.85 to 1.01, P = 0.09). While ɷ-3 FAs reduced the incidences of all-cause death (RR, 0.90; 95 % CI: 0.83 to 0.97, P = 0.005), cardiovascular death (RR, 0.82; 95 % CI: 0.75 to 0.90, P < 0.0001), myocardial infarction (RR, 0.77; 95 % CI: 0.68 to 0.86, P < 0.0001), revascularization (RR, 0.80; 95 % CI: 0.69 to 0.93, P = 0.003), sudden cardiac death (RR, 0.67; 95 % CI: 0.52 to 0.86, P = 0.002) and hospitalization for heart failure or unstable angina pectoris (RR, 0.75; 95 % CI: 0.58 to 0.97, P = 0.03) in CAD. It did not statistically reduce the risk of stroke (RR, 0.96; 95 % CI: 0.77 to 1.21, P = 0.76). The favorable effects of ɷ-3 FAs on MACEs were significant in subgroups of intervention with EPA and baseline triglyceride ≥1.7 mmol/L. CONCLUSION ɷ-3 FAs supplementation, especially EPA, appears to be an effective adjunct therapy for improving the prognosis of CAD. REGISTRATION NUMBER PROSPERO CRD42022311237.
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Affiliation(s)
- Tiantian Chao
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinghui Sun
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yaru Ge
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chenglong Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Dwiputra B, Santoso A, Purwowiyoto BS, Radi B, Pandhita BAW, Fatrin S, Ambari AM. Current Evidence and Future Directions of Omega-3 Supplementation and Cardiovascular Disease Risk. Int J Angiol 2024; 33:1-7. [PMID: 38352637 PMCID: PMC10861298 DOI: 10.1055/s-0043-1777258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Omega-3 supplementation has a controversial role in the secondary prevention of cardiovascular diseases. Despite large clinical trials published over the years, the evidence of omega-3 in preventing cardiovascular diseases, especially coronary heart disease, is still inconclusive. However, recent clinical trials using higher dose of omega-3 or highly purified esters of omega-3 shows promising result, with reduction in cardiovascular death and incidence of cardiovascular disease. This review aims to summarize the possible mechanism of omega-3 in preventing cardiovascular disease and future directions of research regarding the benefit of omega-3 in cardiovascular disease.
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Affiliation(s)
- Bambang Dwiputra
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Anwar Santoso
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Budhi Setianto Purwowiyoto
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Basuni Radi
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Bashar Adi Wahyu Pandhita
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Serlie Fatrin
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
| | - Ade Meidian Ambari
- Deptartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
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Comparative efficacy of omega-3 polyunsaturated fatty acids on major cardiovascular events: A network meta-analysis of randomized controlled trials. Prog Lipid Res 2022; 88:101196. [PMID: 36341839 DOI: 10.1016/j.plipres.2022.101196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
The role of omega-3 polyunsaturated fatty acids (PUFAs) in primary and secondary prevention on major cardiovascular events (MCE) is inconclusive due to the potential heterogeneity in study designs of formulas, dosages, and ratios of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from the findings of previous randomized controlled trials (RCTs). Here we conducted a comprehensive narrative review of pre-clinical studies and updated a network meta-analysis (NMA) to determine the comparative efficacy against MCE with different EPA/DHA dosages and formulas. We found that pure EPA was ranked the best option in the secondary prevention (hazard ratio: 0.72, 95% confidence interval: 0.65 to 0.81) from the NMA of 39 RCTs with 88,359 participants. There was no evidence of omega-3 PUFAs' efficacy in primary prevention. The mechanisms of omega-3 PUFAs' cardiovascular protection might link to the effects of anti-inflammation and stabilization of endothelial function from PUFA's derivatives including eicosanoids and the special pre-resolving mediators (SPMs).
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Yu F, Qi S, Ji Y, Wang X, Fang S, Cao R. Effects of omega-3 fatty acid on major cardiovascular outcomes: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29556. [PMID: 35905212 PMCID: PMC9333496 DOI: 10.1097/md.0000000000029556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The effects of omega-3 fatty acid on cardiovascular health obtained inconsistent results. A systematic review and meta-analysis were therefore conducted to assess the effects of omega-3 fatty acid supplementation for primary and secondary prevention strategies of major cardiovascular outcomes. METHODS The databases of PubMed, Embase, and the Cochrane library were systematically searched from their inception until September 2020. Relative risks (RRs) with 95% confidence intervals were used to assess effect estimates by using the random-effects model. RESULTS Twenty-eight randomized controlled trials involving 136,965 individuals were selected for the final meta-analysis. Omega-3 fatty acid was noted to be associated with a lower risk of major cardiovascular events (RR, 0.94; 95% CI, 0.89-1.00; P = .049) and cardiac death (RR, 0.92; 95% CI, 0.85-0.99; P = .022). However, no significant differences was noted between omega-3 fatty acid and the control for the risks of all-cause mortality (RR, 0.97; 95% CI, 0.92-1.03; P = .301), myocardial infarction (RR, 0.90; 95% CI, 0.80-1.01; P = .077), and stroke (RR, 1.02; 95% CI, 0.94-1.11; P = .694). CONCLUSIONS Major cardiovascular events and cardiac death risks could be avoided with the use of omega-3 fatty acid. However, it has no significant effects on the risk of all-cause mortality, myocardial infarction, and stroke.
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Affiliation(s)
- Fangyu Yu
- Taizhou Hospital of Traditional Chinese Medicine, Taizhou, Zhejiang Province, China
- *Correspondence: Fangyu Yu, Taizhou Hospital of Traditional Chinese Medicine, No. 278 West Zhongshan Road, Jiaojiang District, Taizhou, Zhejiang Province, 318000, China (e-mail: )
| | - Shun Qi
- Taizhou Hospital of Traditional Chinese Medicine, Taizhou, Zhejiang Province, China
| | - Yanan Ji
- Taizhou Hospital of Traditional Chinese Medicine, Taizhou, Zhejiang Province, China
| | - Xizhi Wang
- Taizhou Hospital of Traditional Chinese Medicine, Taizhou, Zhejiang Province, China
| | - Shaohong Fang
- Taizhou Hospital of Traditional Chinese Medicine, Taizhou, Zhejiang Province, China
| | - Ruokui Cao
- Taizhou Hospital of Traditional Chinese Medicine, Taizhou, Zhejiang Province, China
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Docosahexaenoic Acid-Enhanced Autophagic Flux Improves Cardiac Dysfunction after Myocardial Infarction by Targeting the AMPK/mTOR Signaling Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1509421. [PMID: 35265261 PMCID: PMC8898772 DOI: 10.1155/2022/1509421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 11/17/2022]
Abstract
Background and Purpose. Docosahexaenoic acid (DHA) is a type of polyunsaturated fatty acid enriched in cod liver oil and seaweed. It is necessary for the human body and has important functions, such as antioxidation and antiatherosclerosis activities. Long-term oral administration of DHA or the use of DHA at the initial stage of ischemia can increase the level of autophagy and exert a protective effect on neurological functions related to cerebral infarction. However, the effect of DHA on myocardial injury and cardiac insufficiency after myocardial infarction (MI) is unknown. This study was aimed at exploring whether DHA plays a protective role in AMI and its specific molecular mechanism. Experimental Method. In vitro cardiomyocyte hypoxia and in vivo MI injury models were used to determine the role of DHA in MI. Hypoxic injury induced damage in cultured neonatal mouse cardiomyocytes (NMCs). The C57BL/6J mouse MI model was established by permanent ligation of the left anterior descending branch. Main Results. DHA improved the cardiomyocyte viability of NMCs induced by hypoxia injury and reduced cell necrosis. DHA reduced infarct size, improved heart function, and reduced the degree of myocardial fibrosis in mice after MI. In addition, DHA enhanced autophagy flux and reduced apoptosis in vitro and in vivo. In addition, we found that chloroquine, an autophagy inhibitor, blocked the protective effect of DHA on cardiomyocyte apoptosis and cardiac dysfunction, indicating that DHA exerts cardioprotective effects in part by promoting autophagy flux. We also observed that DHA enhanced autophagy flux by activating the AMPK/mTOR signaling pathway. Conclusions and Significance. In conclusion, our findings indicate for the first time that DHA improves MI-induced cardiac dysfunction by promoting AMPK/mTOR-mediated autophagic flux.
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Shen S, Gong C, Jin K, Zhou L, Xiao Y, Ma L. Omega-3 Fatty Acid Supplementation and Coronary Heart Disease Risks: A Meta-Analysis of Randomized Controlled Clinical Trials. Front Nutr 2022; 9:809311. [PMID: 35187035 PMCID: PMC8850984 DOI: 10.3389/fnut.2022.809311] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The clinical benefits of omega-3 fatty acids (FAs) supplementation in preventing and treating coronary heart disease (CHD) remain controversial. Therefore, this study aimed to investigate the clinical benefits of omega-3 FA supplementation, with special attention given to specific subgroups. METHODS Randomized controlled trials (RCTs) that compared the effects of omega-3 FA supplementation for CHD vs. a control group and including at least 1,000 patients were eligible for the inclusion in this meta-analysis. The relative risk (RR) of all-cause death, major adverse cardiovascular events (MACEs), cardiovascular death, myocardial infarction (MI), stroke, and revascularization were estimated. We analyzed the association between cardiovascular risk and omega-3 FA supplementation in the total subjects. We focused on the cardiovascular risk compared to omega-3 FA in subgroups with different development stages of CHD, omega-3 FA supplementation application dose, diabetes, and sex. PROSPERO Registration Number: CRD42021282459. RESULTS This meta-analysis included 14 clinical RCTs, including 1,35,291 subjects. Omega-3 FA supplementation reduced the risk of MACE (RR; 0.95; CI: 0.91-0.99; p for heterogeneity 0.27; I 2 = 20%; p = 0.03), cardiovascular death (RR; 0.94; CI: 0.89-0.99; p for heterogeneity 0.21; I 2 = 25%; p = 0.02), and MI (RR; 0.86; CI: 0.79-0.93; p for heterogeneity 0.28; I 2 = 19%; p < 0.01), but had no significant effect on all-cause death, stroke, and revascularization. In the subgroup analysis, omega-3 FA supplementation decreased the incidence of MACE and cardiovascular death in acute patients with MI, the risk of MI and stroke in patients with CHD, and the risk of MI in patients with high-risk CHD. 0.8-1.2 g omega-3 FA supplementation reduced the risk of MACE, cardiovascular death, and MI. It was revealed that gender and diabetes have no significant association between omega-3 FA supplementation and MACE risk. CONCLUSIONS Omega-3 FA supplementation had a positive effect in reducing the incidence of MACE, cardiovascular death, MI. Regardless of the stage of CHD, omega-3 FA supplementation can prevent the occurrence of MI. The 0.8-1.2 g omega-3 FA supplementation alleviated CHD risk more effectively than lower or higher doses. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier CRD42021282459.
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Affiliation(s)
- ShiChun Shen
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chen Gong
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - KaiQin Jin
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lei Zhou
- Department of Cardiology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Yin Xiao
- Second School of Clinical Medicine of Anhui Medical University, Hefei, China
| | - Likun Ma
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Okada T, Miyoshi T, Doi M, Seiyama K, Takagi W, Sogo M, Nosaka K, Takahashi M, Okawa K, Ito H. Secular Decreasing Trend in Plasma Eicosapentaenoic and Docosahexaenoic Acids among Patients with Acute Coronary Syndrome from 2011 to 2019: A Single Center Descriptive Study. Nutrients 2021; 13:nu13010253. [PMID: 33477264 PMCID: PMC7829914 DOI: 10.3390/nu13010253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/21/2022] Open
Abstract
Despite intensive lipid-lowering interventions, patients treated with statins develop atherosclerotic cardiovascular disease (ASCVD), and these patients have an increased risk of developing recurrent cardiovascular events during follow-up. Therefore, there is a need to focus on the residual risks in patients in statin therapy to further reduce ASCVD. The aim of this study was to retrospectively investigate the 10-year trend (2011–2019) regarding changes in polyunsaturated fatty acids (PUFAs) in patients with acute coronary syndrome (ACS) in a single center. We included 686 men and 203 women with ACS admitted to Kagawa Prefectural Central Hospital. Plasma PUFAs, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), and dihomo-γ-linolenic acid (DGLA), were measured at admission for suspected ACS. A secular decreasing trend in the levels of EPA and DHA and the EPA/AA ratio, but not of AA and DGLA, was observed. The analyses based on age (>70 or <70 years) and sex showed that the decreasing trend in the levels of EPA and DHA did not depend on age and remained significant only in men. Further studies are needed to obtain robust evidence to justify that the administration of n-3 PUFA contributes to the secondary prevention of ACS.
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Affiliation(s)
- Tomoaki Okada
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City 760-8557, Japan; (T.O.); (M.D.); (K.S.); (W.T.); (M.S.); (K.N.); (M.T.); (K.O.)
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama City 700-8558, Japan;
- Correspondence: ; Tel.: +81-86-235-7351
| | - Masayuki Doi
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City 760-8557, Japan; (T.O.); (M.D.); (K.S.); (W.T.); (M.S.); (K.N.); (M.T.); (K.O.)
| | - Kosuke Seiyama
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City 760-8557, Japan; (T.O.); (M.D.); (K.S.); (W.T.); (M.S.); (K.N.); (M.T.); (K.O.)
| | - Wataru Takagi
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City 760-8557, Japan; (T.O.); (M.D.); (K.S.); (W.T.); (M.S.); (K.N.); (M.T.); (K.O.)
| | - Masahiro Sogo
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City 760-8557, Japan; (T.O.); (M.D.); (K.S.); (W.T.); (M.S.); (K.N.); (M.T.); (K.O.)
| | - Kazumasa Nosaka
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City 760-8557, Japan; (T.O.); (M.D.); (K.S.); (W.T.); (M.S.); (K.N.); (M.T.); (K.O.)
| | - Masahiko Takahashi
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City 760-8557, Japan; (T.O.); (M.D.); (K.S.); (W.T.); (M.S.); (K.N.); (M.T.); (K.O.)
| | - Keisuke Okawa
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City 760-8557, Japan; (T.O.); (M.D.); (K.S.); (W.T.); (M.S.); (K.N.); (M.T.); (K.O.)
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama City 700-8558, Japan;
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Abstract
Several countries have issued dietary recommendations about total and specific fatty acid (FA) intake for the prevention of CHD. For many years until today, controversies have existed especially about the deleterious effect or not of SFA, and the protective effect or not of n-3 PUFA, so that some authors have criticised these recommendations. There are many reasons for these controversies, including the different conclusions of prospective cohort studies compared with randomised clinical trials (RCT), and the contradictory conclusions of meta-analyses depending on the quality, number and type of studies included. The interrelationships between different FA in the diet make it difficult to analyse the specific effect of a particular class of FA on CHD. Furthermore, based on clinical practice and effectiveness of population-based prevention, it is very difficult at the individual level to assess in personal dietary intake the actual percentage and/or amount of SFA contained in each meal or consumed daily/weekly. In this critical narrative review, we try to answer the question of whether it would not be more relevant, in 2020, to promote dietary patterns, rather than FA intake recommendations. We critically analyse past and recent data on the association of FA with CHD, then propose that the Mediterranean diet and Japanese diet should be revitalised for Westerners and Asian populations, respectively. This does not exclude the usefulness of continuing research about effects of FA towards CHD, and accepting that what seems true today might be revised, at least partially tomorrow.
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Tognola C, Alessandro M, Milani M, Cartella I, Tavecchia G, Grasso E, Sun J, Giannattasio C. Nutraceuticals in Chronic Coronary Syndromes: Preclinical Data and Translational Experiences. High Blood Press Cardiovasc Prev 2021; 28:13-25. [PMID: 33125662 PMCID: PMC7864844 DOI: 10.1007/s40292-020-00416-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
Non-pharmacological treatments have always been considered important in the management of Chronic Coronary Syndromes. Nutraceuticals ("Nutrition" + "Pharmaceutical") could fall both under the definition of non-pharmacological treatment and pharmacological one or, probably more correctly, in the middle of these two kinds of therapies. However, the word "nutraceuticals" never appears in the latest guidelines on this issue. This is probably determined by the fact that evidences on this topic are scarce and most of the published articles are based on preclinical data while translational experiences are available only for some molecules. In this review we will focus on nutraceutical strategies that act on the ischemic myocardium itself and not only on the cardiovascular risk factors. As demonstrated by the important number of papers published in recent years, this is an evolving topic and evaluated substances principally act on two mechanisms (cardiac energetics and ischemia-reperfusion damage) that will be also reviewed.
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Affiliation(s)
- Chiara Tognola
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Maloberti Alessandro
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
| | - Martina Milani
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Iside Cartella
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Giovanni Tavecchia
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Enzo Grasso
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Jinwey Sun
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Cristina Giannattasio
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
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Colucci P, De Castro V, Peloso A, Splendori M, Trezza V, Campolongo P. Perinatal exposure to omega-3 fatty acid imbalance leads to early behavioral alterations in rat pups. Behav Brain Res 2020; 392:112723. [DOI: 10.1016/j.bbr.2020.112723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 01/05/2023]
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Arnold SV, Bhatt DL, Barsness GW, Beatty AL, Deedwania PC, Inzucchi SE, Kosiborod M, Leiter LA, Lipska KJ, Newman JD, Welty FK. Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e779-e806. [PMID: 32279539 DOI: 10.1161/cir.0000000000000766] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although cardiologists have long treated patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (T2DM), T2DM has traditionally been considered just a comorbidity that affected the development and progression of the disease. Over the past decade, a number of factors have shifted that have forced the cardiology community to reconsider the role of T2DM in CAD. First, in addition to being associated with increased cardiovascular risk, T2DM has the potential to affect a number of treatment choices for CAD. In this document, we discuss the role that T2DM has in the selection of testing for CAD, in medical management (both secondary prevention strategies and treatment of stable angina), and in the selection of revascularization strategy. Second, although glycemic control has been recommended as a part of comprehensive risk factor management in patients with CAD, there is mounting evidence that the mechanism by which glucose is managed can have a substantial impact on cardiovascular outcomes. In this document, we discuss the role of glycemic management (both in intensity of control and choice of medications) in cardiovascular outcomes. It is becoming clear that the cardiologist needs both to consider T2DM in cardiovascular treatment decisions and potentially to help guide the selection of glucose-lowering medications. Our statement provides a comprehensive summary of effective, patient-centered management of CAD in patients with T2DM, with emphasis on the emerging evidence. Given the increasing prevalence of T2DM and the accumulating evidence of the need to consider T2DM in treatment decisions, this knowledge will become ever more important to optimize our patients' cardiovascular outcomes.
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Vara-Messler M, Mukdsi JH, Osieki NI, Benizio E, Repossi GM, Ajayi EIO, García NH. Eicosapentaenoic acid prevents salt sensitivity in diabetic rats and decreases oxidative stress. Nutrition 2019; 72:110644. [PMID: 32044546 DOI: 10.1016/j.nut.2019.110644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 11/02/2019] [Accepted: 11/02/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Salt sensitivity (SS) is associated with increased cardiovascular risk in patients with Type 2 diabetes mellitus (T2-DM) due to an increase in renal oxidation. ω-3 polyunsaturated fatty acids have shown antioxidant effects, but a typical Western diet contains limited content. In particular, ω-3 polyunsaturated fatty acids are able to activate nuclear factor erythroid 2-related factor 2 (Nrf-2) to prevent diabetes mellitus-related complications by mitigating oxidative stress. Therefore, we hypothesized that eicosapentaenoic acid (EPA; ω-3) modulates SS in rats with T2-DM by decreasing renal oxidative stress via Nrf-2 activation and enhancing the antiinflammatory response via interleukin (IL) 6 modulation. METHODS Three-month-old male rats (n = 40) were fed with a Normal Na-diet (NNaD) and randomly selected into four groups: Healthy Wistar nondiabetic rats (Wi), diabetic controls (eSS), arachidonic acid-treated eSS (AA; ω-6), and EPA-treated eSS (ω-3). After 1 year, rats were placed in metabolic cages for 7 d and fed a NNaD, followed by a 7-d period with a High Na-diet (HNaD). Systolic blood pressure, body weight, serum IL-6 and reactive oxygen species (ROS) levels were determined at the end of each 7-d period. Glycated hemoglobin (HbA1c), triacylglycerol, creatinine, and cholesterol levels were determined. ROS levels and Nrf-2 expression in kidney lysates were also assayed. Histologic changes were evaluated. A t test or analysis of variance was used for the statistical analysis. RESULTS After a HNaD, systolic blood pressure increased in both the control eSS and AA groups, but not in the EPA and Wi groups. However, HbA1c levels remained unchanged by the treatments, which suggests that the observed beneficial effect was independent of HbA1c levels. The IL-6 levels were higher in the eSS and AA groups, but remained unaltered in EPA and Wi rats after a HNaD diet. Interestingly, EPA protected against serum ROS in rats fed the HNaD, whereas AA did not. In kidney lysates, ROS decreased significantly in the EPA group compared with the eSS group, and Nrf-2 expression was consistently higher compared with the AA and eSS groups. Diabetic rats presented focal segmental sclerosis, adherence to Bowman capsule, and mild-to-moderate interstitial fibrosis. EPA and AA treatment prevented kidney damage. CONCLUSIONS An adequate ω3-to-ω6 ratio prevents SS in diabetic rats by a mechanism that is independent of glucose metabolism but associated with the prevention of renal oxidative stress generation. These data suggest that EPA antioxidant properties may prevent the development of hypertension or kidney damage.
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Affiliation(s)
| | - Jorge H Mukdsi
- Instituto de Investigaciones en Ciencias de la Salud de Córdoba, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Natalia I Osieki
- Instituto de Investigaciones en Ciencias de la Salud de Córdoba, Universidad Nacional de Córdoba, Córdoba, Argentina; Instituto de Biología Celular, Cátedra de Biología Celular, Histología y Embriología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Evangelina Benizio
- Instituto de Investigaciones en Ciencias de la Salud de Córdoba, Universidad Nacional de Córdoba, Córdoba, Argentina; Instituto de Biología Celular, Cátedra de Biología Celular, Histología y Embriología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Gastón M Repossi
- Instituto de Investigaciones en Ciencias de la Salud de Córdoba, Universidad Nacional de Córdoba, Córdoba, Argentina; Instituto de Biología Celular, Cátedra de Biología Celular, Histología y Embriología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ebenezer I O Ajayi
- DC&ONID, Biochemistry Department, Osun State University, Osogbo, Nigeria; IMMF-INIMEC-Universidad Nacional de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
| | - Néstor H García
- Instituto de Investigaciones en Ciencias de la Salud de Córdoba, Universidad Nacional de Córdoba, Córdoba, Argentina.
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Piccinin E, Cariello M, De Santis S, Ducheix S, Sabbà C, Ntambi JM, Moschetta A. Role of Oleic Acid in the Gut-Liver Axis: From Diet to the Regulation of Its Synthesis via Stearoyl-CoA Desaturase 1 (SCD1). Nutrients 2019; 11:nu11102283. [PMID: 31554181 PMCID: PMC6835877 DOI: 10.3390/nu11102283] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022] Open
Abstract
The consumption of an olive oil rich diet has been associated with the diminished incidence of cardiovascular disease and cancer. Several studies have attributed these beneficial effects to oleic acid (C18 n-9), the predominant fatty acid principal component of olive oil. Oleic acid is not an essential fatty acid since it can be endogenously synthesized in humans. Stearoyl-CoA desaturase 1 (SCD1) is the enzyme responsible for oleic acid production and, more generally, for the synthesis of monounsaturated fatty acids (MUFA). The saturated to monounsaturated fatty acid ratio affects the regulation of cell growth and differentiation, and alteration in this ratio has been implicated in a variety of diseases, such as liver dysfunction and intestinal inflammation. In this review, we discuss our current understanding of the impact of gene-nutrient interactions in liver and gut diseases, by taking advantage of the role of SCD1 and its product oleic acid in the modulation of different hepatic and intestinal metabolic pathways.
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Affiliation(s)
- Elena Piccinin
- Clinica Medica Cesare Frugoni, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy.
| | - Marica Cariello
- Clinica Medica Cesare Frugoni, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy.
| | - Stefania De Santis
- Clinica Medica Cesare Frugoni, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy.
- INBB, National Institute for Biostructures and Biosystems, 00136 Rome, Italy.
- Department of Pharmacy-Drug Science, University of Bari "Aldo Moro", 70126 Bari, Italy.
| | - Simon Ducheix
- Institut du thorax, INSERM, CNRS, University of Nantes, 44007 Nantes, France.
| | - Carlo Sabbà
- Clinica Medica Cesare Frugoni, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy.
| | - James M Ntambi
- Departments of Biochemistry and of Nutritional Sciences, University of Wisconsin, Madison, WI 53706, USA.
| | - Antonio Moschetta
- Clinica Medica Cesare Frugoni, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy.
- INBB, National Institute for Biostructures and Biosystems, 00136 Rome, Italy.
- IRCCS Istituto Tumori Giovanni Paolo II, 70124 Bari, Italy.
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