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Daidj NBB, Lamri-Senhadji M. Hepatoprotective and Anti-Obesity Properties of Sardine By-Product Oil in Rats Fed a High-Fat Diet. Prev Nutr Food Sci 2021; 26:285-295. [PMID: 34737989 PMCID: PMC8531423 DOI: 10.3746/pnf.2021.26.3.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 12/19/2022] Open
Abstract
Excess lipid intake can trigger liver lipid accumulation and oxidative responses, which can lead to metabolic disturbances and contribute to hepatic steatosis and obesity and increase the risk of cardiovascular disease. Production of fish oil rich in omega-3 is a good opportunity for valorizing fish by-products in the therapeutic field. In this study, we explored the effects of oil from Sardina pilchardus by-products on cardiometabolic and oxidative disorders caused by toxic effects of excess lipids in obese rats. Three groups of obese rats received either 20% sardine by-product oil (SBy-Ob-HS; experimental group), 20% fillet oil (SF-Ob-HS; positive control group), or a high-fat diet (Ob-HS). Normal weight rats received a standard diet (normal). There was a significant decrease in serum total cholesterol (TC), triacylglycerols (TG), and insulin concentrations in the SBy-Ob-HS group compared with the SF-Ob-HS group. Compared with the Ob-HS group, TC and TG, glycemia, glycosylated hemoglobin, and insulinemia were decreased in the SBy-Ob-HS (more notably) and SF-Ob-HS groups. Furthermore, hepatic lipids, low density lipoprotein-cholesterol (C), the non-esterified cholesterol/phos-pholipids ratio, serum transaminases activities and lipid peroxidation were lower and serum high density lipoproteins-C were higher in the SBy-Ob-HS and SF-Ob-HS groups compared with the Ob-HS group. Serum isoprostane concentrations were reduced in the SBy-Ob-HS (more notably) and SF-Ob-HS groups compared with the Ob-HS and normal groups. The activities of antioxidant enzymes in tissues were enhanced, particularly in the by-product oil group. The oil extracted from by-products demonstrate anti-obesity properties (hypolipemiant, hepatoprotective, antiatherogenic, antidiabetic, and antioxidant) that may be beneficial for the management of obesity and its complications, such as hepatic steatosis.
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Affiliation(s)
- Nabila Boukhari Benahmed Daidj
- Laboratory of Clinical and Metabolic Nutrition, Faculty of Nature and Life Sciences, Oran 31100, Algeria.,Higher School of Biological Sciences of Oran (ESSBO), University Oran 1 Ahmed Ben Bella, Oran 31100, Algeria
| | - Myriem Lamri-Senhadji
- Laboratory of Clinical and Metabolic Nutrition, Faculty of Nature and Life Sciences, Oran 31100, Algeria
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Watanabe Y, Tatsuno I. Omega-3 polyunsaturated fatty acids focusing on eicosapentaenoic acid and docosahexaenoic acid in the prevention of cardiovascular diseases: a review of the state-of-the-art. Expert Rev Clin Pharmacol 2020; 14:79-93. [PMID: 33306922 DOI: 10.1080/17512433.2021.1863784] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION : An epidemiological study of Greenlandic Inuit suggested the importance of omega-3 polyunsaturated fatty acids (PUFAs) in preventing ischemic heart disease. After this landmark study, large-scale epidemiological studies have examined the benefits of omega-3 PUFAs in the prevention of cardiovascular diseases. AREAS COVERED : This article reviews studies on omega-3 PUFAs, and identifies issues relevant to cardiovascular risk. EXPERT OPINION : Recent studies have focused on the anti-inflammatory effects of omega-3 PUFAs and specialized pro-resolving mediators. High-purity eicosapentaenoic acid (EPA) ethyl ester and EPA/docosahexaenoic acid (DHA) preparations have been developed primarily for the treatment of hypertriglyceridemia. Various trials on the cardiovascular protective effects of omega-3 PUFAs have been reported, but the results have not been consistent. Some issues of the trials have been suggested, such as using low-dose omega-3 PUFAs and not including hypertriglyceridemia in subject selection criteria. REDUCE-IT study that used a high dose of high-purity EPA preparation showed a relative reduction in cardiovascular events, but, the STRENGTH study that used a high dose of EPA/DHA preparation did not support this benefit. This article reviews the roles of omega-3 PUFAs in cardiovascular diseases, including progress in understanding the molecular mechanisms and recent large-scale clinical trials.
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Affiliation(s)
- Yasuhiro Watanabe
- Center for Diabetes, Metabolism and Endocrinology, Toho University Sakura Medical Center , Chiba, Japan
| | - Ichiro Tatsuno
- Center for Diabetes, Metabolism and Endocrinology, Toho University Sakura Medical Center , Chiba, Japan
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Asfaw A, Minhas S, Khouzam AR, Khouzam NR, Khouzam RN. Fish Oil Dilemma: Does It Increase the Risk of Ventricular Arrhythmias and Death? Can Fish Oil Kill You? Curr Probl Cardiol 2020; 46:100718. [PMID: 33097299 DOI: 10.1016/j.cpcardiol.2020.100718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
Omega-3-fatty-acids are now increasingly being used for potential beneficial anti-inflammatory effect in the treatment and management of cardiovascular disease. Eicosapentaenoic acid and Docosahexaenoic acid are 2 essential omega-3 fatty acids found predominately in fish and fish oil supplements. Despite the increased use of fish oil products for both primary and secondary prevention of cardiovascular morbidity and mortality, the available literature evidence are controversial. We searched through PubMed for studies that have investigated the impact of omega-3 fatty acids on coronary heart disease and mortality. Our systemic review suggests that most studies, which are mostly observational, have found there to be a potential benefit of omega-3 fatty acids on coronary heart disease whereas some other studies have found conflicting results. More randomized controlled studies are warranted with adequate sample size to clearly establish the risk and benefits of omega-3 fatty acids on cardiovascular disease.
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Watanabe Y, Tatsuno I. Prevention of Cardiovascular Events with Omega-3 Polyunsaturated Fatty Acids and the Mechanism Involved. J Atheroscler Thromb 2020; 27:183-198. [PMID: 31582621 PMCID: PMC7113138 DOI: 10.5551/jat.50658] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022] Open
Abstract
An epidemiological study of Greenlandic Inuit suggested that fish oil, or omega-3 polyunsaturated fatty acids (PUFA), was important in preventing atherosclerotic disease. After this landmark study, many large-scale epidemiological studies and meta-analyses have examined the health benefits of omega-3 PUFA as part of a fatty acid-rich diet to demonstrate its beneficial roles in the prevention of cardiovascular diseases. Recent research has also focused attention on the anti-inflammatory effects of omega-3 PUFA and on specialized pro-resolving mediators. Findings of these studies have led to the development of omega-3 PUFA preparations for the treatment of dyslipidemia, including a highly purified eicosapentaenoic acid (EPA)-ethyl ester product (Epadel®) in Japan and an EPA/docosahexaenoic acid (DHA) preparation (Lotriga®) in the United States and Europe. Although various large-scale clinical trials on the cardiovascular preventive effect of omega-3 PUFA were conducted and reported, the results were not always consistent. The issues of not targeting subjects with hypertriglyceridemia and using low dose of omega-3 PUFA have been suggested to contribute to the failure of demonstrating the preventive effect of omega-3 PUFA in these clinical trials. Taking into account the above issues, the REDUCE-IT trial evaluated a highly purified EPA preparation at a high dose of 4 g/day in patients with hypertriglyceridemia and high cardiovascular risk, and demonstrated an extraordinary outcome of 25% relative reduction in cardiovascular events. This article reviews studies on omega-3 fatty acids during the last 50 years, including the progress in elucidating molecular mechanisms and recent large-scale clinical studies.
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Affiliation(s)
- Yasuhiro Watanabe
- Center for Diabetes, Metabolism and Endocrinology, Toho University Sakura Medical Center, Chiba, Japan
| | - Ichiro Tatsuno
- Center for Diabetes, Metabolism and Endocrinology, Toho University Sakura Medical Center, Chiba, Japan
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Simplice MR, Macaire WH, Hervé NNF, Fabrice TD, Justin DDJ, François T, Jules-Roger K. Chemical composition and antibacterial activity of oils from Chrysicthys nigrodigitatus and Hepsetus odoe, two freshwater fishes from Yabassi, Cameroon. Lipids Health Dis 2018. [PMID: 29530030 PMCID: PMC5848570 DOI: 10.1186/s12944-018-0690-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Backgrounds Oils of fish origin are a very rich source of Omega − 3 and Omega − 6 fatty acids. They have been suggested to provide numerous health benefits for humans involving antimicrobial properties. Chrysichthys nigrodigitatus and Hepsetus odoe are two fishes well known in Cameroon. The chemical composition and the antibacterial activity of these fishes derived oils are unknown. The study was designed to valorise C. nigrodigitatus and H.s odoe oils activity against food poisoning bacteria. Methods Oils were extracted by pressing and maceration methods. Their quality was assessed by analysing quality indexes including peroxides, acid, iodine, anisidine and thiobarbituric acid values. Chemical analysis was established by gas chromatography coupled to flame ionization detector. Antibacterial activity was evaluated by broth microdilution method. Results C. nigrodigitatus oil obtained by maceration exhibited highest acid (7.33 ± 0.00 mg KOH/g), anisidine (34.5 ± 1.84) and thiobarbituric acid (7.50 ± 0.30 μmol MDA/Kg) values compared to that obtained by pressing method (9.13 ± 0.64 and 6.72 ± 0.34 μmol MDA/Kg) respectively. H. odoe oil obtained by pressing method showed highest peroxide value (6.22 ± 1.31 meq O2/kg). Oil chemical analysis revealed long chain polyunsaturated fatty acids of the ω-3 family: linolenic acid (C18:3); eicosapentaenoic acid (C20:5) and docosahexaenoic acid (C22:6) and ω-6 family; arachidonic acid (C20:4). In addition, C. nigrodigitatus oil obtained by pressing and maceration methods showed Minimum Inhibitory Concentrations (MIC) values ranging from 32 to 64 mg/ml. H. odoe oil obtained by pressing method revealed MIC values ranging between 8 and 64 mg/ml. Conclusions C. nigrodigitatus and H. odoe oils have activity against food poisoning bacteria, due to their chemical composition.
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Affiliation(s)
- Mouokeu Raymond Simplice
- Laboratory of Fisheries Resources, Institute of Fisheries and Aquatic Sciences, University of Douala, Po Box 7236, Douala, Cameroon.
| | - Womeni Hilaire Macaire
- Laboratory of Biochemistry of Medicinal Plants, Food Sciences and Nutrition, University of Dschang, Po Box 67, Dschang, Cameroon
| | - Njike Ngamga Fabrice Hervé
- Laboratory of Biochemistry of Medicinal Plants, Food Sciences and Nutrition, University of Dschang, Po Box 67, Dschang, Cameroon
| | - Tonfack Djikeng Fabrice
- Laboratory of Biochemistry of Medicinal Plants, Food Sciences and Nutrition, University of Dschang, Po Box 67, Dschang, Cameroon
| | - Djopnang DJimbie Justin
- Laboratory of Fisheries Resources, Institute of Fisheries and Aquatic Sciences, University of Douala, Po Box 7236, Douala, Cameroon
| | - Tchoumbougnang François
- Laboratory of Fisheries Resources, Institute of Fisheries and Aquatic Sciences, University of Douala, Po Box 7236, Douala, Cameroon
| | - Kuiate Jules-Roger
- Laboratory of Microbiology and Antimicrobial Substances, University of Dschang, Faculty of Science, Po box 67, Dschang, Cameroon
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Abstract
In this review, the pro- and anti-arrhythmic effects of a diet rich in fish oil fatty acids and of hypercholesterolemia will be discussed in relation to two major mechanisms of arrhythmogenesis (triggered activity and re-entry). Whereas a diet rich in fish oil is pro-arrhythmic in relation to re-entry based arrhythmias (as occur in acute myocardial ischemia) and anti-arrhythmic in relation to triggered activity based arrhythmias (as occur in heart failure), the reverse is true for hypercholesterolemia. Changing the lipid composition of cardiomyocytes likely has powerful pro- or anti-arrhythmic consequences, depending on the mechanism of arrhythmias, and has corresponding therapeutic potential.
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Affiliation(s)
- R Coronel
- Dept. Exp. Cardiology, Academic Medical Center, Amsterdam, The Netherlands; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac Bordeaux, France.
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Khawaja OA, Gaziano JM, Djoussé L. N-3 fatty acids for prevention of cardiovascular disease. Curr Atheroscler Rep 2015; 16:450. [PMID: 25214423 DOI: 10.1007/s11883-014-0450-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the USA. A diet enriched with n-3 fatty acids (FA) has been reported to play an important role in preventing the development of CVD. Prior studies have demonstrated beneficial effects of n-3 FA on hypertriglyceridemia, blood pressure, inflammation, endothelial function, and platelet function. However, data on the relation of n-3 FA consumption with CVD risk remain inconsistent. This paper reviews current evidence on the effects of n-3 FA on CVD, CVD risk factors, and potential biologic mechanisms. Last, we discuss major limitations of currently available data and future directions in the field.
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Affiliation(s)
- Owais A Khawaja
- Department of Cardiology, Mercy St. Vincent Medical Center, 2213 Cherry Street, Toledo, OH, 43608, USA,
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Lipids and Health. Lipids 2014. [DOI: 10.1201/b17656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tatsuno I. Omega-3 polyunsaturated fatty acids and cardiovascular disease: an emphasis on omega-3-acid ethyl esters 90 for the treatment of hypertriglyceridemia. Expert Rev Cardiovasc Ther 2014; 12:1261-8. [PMID: 25319059 DOI: 10.1586/14779072.2014.971756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A number of epidemiological/observational studies, as well as large-scale randomized intervention studies, have been conducted to provide evidence for the efficacy of ω-3 fatty acids against atherosclerotic diseases. Currently, ω-3 fatty acids are commercially available in many parts of the world containing the same active ingredients as Lotriga(®) (ω-3-acid ethyl esters 90 [O3AE highly concentrated ω-3 fatty acid ethyl esters, consisting of eicosapentaenoic acid-ethyl ester and docosahexaenoic acid-ethyl ester [EPA-E/DHA-E]). A recent head-to-head comparative study of O3AEE90 versus EPA-E demonstrated that O3AEE90 4g/day led to a significantly greater reduction in triglycerides (TG) than EPA-E 1.8g/day and that O3AEE90 2g/day produced comparable effects on TG to those with EPA-E 1.8g/day. While both agents were shown to be useful in lowering TG, the hallmark feature of O3AEE90, that is, the presence of the DHA-E component versus its absence in EPA-E, needs to be further examined for its clinical implications.
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Affiliation(s)
- Ichiro Tatsuno
- Center for Diabetes, Metabolism and Endocrinology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741, Japan
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Ardashev A, Zhelyakov E, Kuzovlev O. Antiarrhythmogenic effect of omega-3 fatty acid ethyl esters in a patient treated with Omacor after a non-Q-wave myocardial infarction. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Fares H, Lavie CJ, DiNicolantonio JJ, O’Keefe JH, Milani RV. Omega-3 Fatty Acids: A Growing Ocean of Choices. Curr Atheroscler Rep 2014; 16:389. [DOI: 10.1007/s11883-013-0389-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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12
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Billman GE. The effects of omega-3 polyunsaturated fatty acids on cardiac rhythm: a critical reassessment. Pharmacol Ther 2013; 140:53-80. [PMID: 23735203 DOI: 10.1016/j.pharmthera.2013.05.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 11/28/2022]
Abstract
Although epidemiological studies provide strong evidence for an inverse relationship between omega-3 polyunsaturated fatty acids (n-3 PUFAs) and cardiac mortality, inconsistent and often conflicting results have been obtained from both animal studies and clinical prevention trials. Despite these heterogeneous results, some general conclusions can be drawn from these studies: 1) n-PUFAs have potent effects on ion channels and calcium regulatory proteins that vary depending on the route of administration. Circulating (acute administration) n-3 PUFAs affect ion channels directly while incorporation (long-term supplementation) of these lipids into cell membranes indirectly alter cardiac electrical activity via alteration of membrane properties. 2) n-3 PUFAs reduce baseline HR and increase HRV via alterations in intrinsic pacemaker rate rather than from changes in cardiac autonomic neural regulation. 3) n-3 PUFAs may be only effective if given before electrophysiological or structural remodeling has begun and have no efficacy against atrial fibrillation. 5) Despite initial encouraging results, more recent clinical prevention and animal studies have not only failed to reduce sudden cardiac death but actually increased mortality in angina patients and increased rather than decreased malignant arrhythmias in animal models of regional ischemia. 6) Given the inconsistent benefits reported in clinical and experimental studies and the potential adverse actions on cardiac rhythm noted during myocardial ischemia, n-3 PUFA must be prescribed with caution and generalized recommendations to increase fish intake or to take n-3 PUFA supplements need to be reconsidered.
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Affiliation(s)
- George E Billman
- Department of Physiology and Cell Biology, The Ohio State University, 304 Hamilton Hall, 1645 Neil Ave., Columbus, OH 43210-1218, United States.
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Khoueiry G, Abi Rafeh N, Sullivan E, Saiful F, Jaffery Z, Kenigsberg DN, Krishnan SC, Khanal S, Bekheit S, Kowalski M. Do omega-3 polyunsaturated fatty acids reduce risk of sudden cardiac death and ventricular arrhythmias? A meta-analysis of randomized trials. Heart Lung 2013; 42:251-6. [PMID: 23714269 DOI: 10.1016/j.hrtlng.2013.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 03/15/2013] [Accepted: 03/19/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Omega-3 polyunsaturated fatty acids (PUFA) have demonstrated to have antiarrhythmic properties. However, randomized studies have shown inconsistent results. OBJECTIVE We aimed to analyze the effect of omega-3 PUFA on preventing potentially fatal ventricular arrhythmias and sudden cardiac death. METHODS Randomized trials comparing omega-3 PUFA to placebo and reporting sudden cardiac death (SCD) or first implanted cardioverter-defibrillator (ICD) event for ventricular tachycardia or fibrillation were included in this study. A meta-analysis using a random effects model was performed and results were expressed in terms of Odds Ratio (OR) and 95% Confidence Interval (CI) after evaluating for interstudy heterogeneity using I(2). The reported data were extracted on the basis of the intention-to-treat principle. RESULTS A total of 32,919 patients were included in nine trials; 16,465 patients received omega-3 PUFA and 16,454 received placebo. When comparing omega-3 PUFA to placebo, there was nonsignificant risk reduction of SCD or ventricular arrhythmias (OR = 0.82 [95% CI: 0.60-1.21], p = 0.21 I(2) = 49.7%). CONCLUSION Dietary supplementation with omega-3 PUFA does not affect the risk of SCD or ventricular arrhythmias.
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Affiliation(s)
- Georges Khoueiry
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001, USA.
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Kazemian P, Kazemi-Bajestani SMR, Alherbish A, Steed J, Oudit GY. The use of ω-3 poly-unsaturated fatty acids in heart failure: a preferential role in patients with diabetes. Cardiovasc Drugs Ther 2012; 26:311-20. [PMID: 22644698 DOI: 10.1007/s10557-012-6397-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To review the evidence for a beneficial effect of ω-3 PUFAs in heart failure (HF) and its co-morbidities, their possible preferential effect in diabetes and the potential mechanism for their benefit. METHODS We summarize the clinical studies which investigated the use of ω-3 PUFAs in patients with HF with an emphasis on diabetes. We briefly summarize the evidence for an effect of ω-3 PUFAs in patients with coronary artery disease (CAD), atrial fibrillation (AF) and ventricular arrhythmias. We also discuss the proposed mechanisms of ω-3 PUFA action in cardiovascular diseases. RESULTS While there is emerging evidence for a beneficial effect of ω-3 PUFA supplementation in patients with HF, the evidence for other indications have been variable and conflicting. In HF patients with diabetes, ω-3 PUFAs may have a preferential therapeutic benefit. Randomized controlled trials did not show considerable beneficial effects of ω-3 PUFAs in other conditions such as CAD and AF. In a diabetic and insulin-resistant state, ω-3 PUFAs bind to the G-protein coupled receptor, GPR120, resulting in reduced cytokine production from inflammatory macrophages and improved signaling in adipocytes, leading to a reduction in insulin resistance. CONCLUSIONS There is promising evidence showing that use of ω-3 PUFA supplementation improves clinical outcomes of HF patients with diabetes. Further clinical trials are needed in this regard.
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Affiliation(s)
- Pedram Kazemian
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
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Aarsetoey H, Grundt H, Nygaard O, Nilsen DWT. The role of long-chained marine N-3 polyunsaturated Fatty acids in cardiovascular disease. Cardiol Res Pract 2012; 2012:303456. [PMID: 23304630 PMCID: PMC3532917 DOI: 10.1155/2012/303456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 10/11/2012] [Accepted: 10/25/2012] [Indexed: 01/27/2023] Open
Abstract
This paper reviews the current evidence regarding long-chained marine omega-3 polyunsaturated fatty acids (PUFAs) and cardiovascular disease (CVD), their possible mechanisms of action, and results of clinical trials. Also, primary and secondary prevention trials as studies on antiarrhythmic effects and meta-analyses are summarized. However, the individual bioavailability of n-3 PUFAs along with the highly different study designs and estimations of FAs intake or supplementation dosages in patient populations with different background intake of n-3 PUFAs might be some of the reasons for the inconsistent findings of the studies evaluating the impact of n-3 PUFAs on CVD. The question of an optimum dose of n-3 PUFAs or whether there exists a dose-response relation for n-3 PUFA supplementation is widely discussed. Moreover, the difficulties in interpreting meta-analyses are clearly demonstrated by two recently published meta-analyses (Rizos et al. and Delgado Lista et al.), evaluating the efficacy of n-3 PUFAs on CVD, including 12 common studies, but drawing opposite conclusions. We definitely need more large-scale, randomized clinical trials of long duration, also reporting harmful effects of n-3 PUFAs.
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Affiliation(s)
- Hildegunn Aarsetoey
- Department of Medicine, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Heidi Grundt
- Department of Medicine, Stavanger University Hospital, 4011 Stavanger, Norway
- Institute of Medicine, University of Bergen, 5020 Bergen, Norway
| | - Ottar Nygaard
- Institute of Medicine, University of Bergen, 5020 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway
| | - Dennis W. T. Nilsen
- Institute of Medicine, University of Bergen, 5020 Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, 4011 Stavanger, Norway
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Billman GE. Omega-3 polyunsaturated fatty acids and cardiac rhythm: an introduction. Front Physiol 2012; 3:457. [PMID: 23230422 PMCID: PMC3515776 DOI: 10.3389/fphys.2012.00457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 11/19/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- George E. Billman
- Department of Physiology and Cell Biology, The Ohio State UniversityColumbus, OH, USA
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Khawaja O, Gaziano JM, Djoussé L. A meta-analysis of omega-3 fatty acids and incidence of atrial fibrillation. J Am Coll Nutr 2012; 31:4-13. [PMID: 22661621 DOI: 10.1080/07315724.2012.10720003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Atrial fibrillation (AF) is associated with higher health care costs. Although omega-3 (n-3) fatty acids have been associated with a decreased risk of coronary heart disease, their effects on the risk of AF are inconsistent. We therefore sought to review the relation between n-3 fatty acids and the risk of AF. METHODS Using an extensive online search, we conducted a meta-analysis of new onset incident/recurrent AF following exposure to fish/fish oil or long-chain n-3 polyunsaturated fatty acids. A random-effect model was used and between-studies heterogeneity was estimated with I(2). The quality of studies was assessed using Jadad and United States Preventive Services Task Force (USPSTF) scoring systems. All analyses were performed with RevMan (version 5.0.20). RESULTS Seven cohort studies and 11 randomized controlled trials (RCTs) were included in this meta-analysis. The pooled odds ratio (OR) was 0.79 (95% confidence interval [CI] = 0.56-1.12; p = 0.19) for RCTs and 0.83 (95% CI = 0.59-1.16; p = 0.27) for cohort studies. On sensitivity analysis, no statistically significant difference was noted when stratified by study design or quality of the studies (as graded by Jadad or USPSTF scoring systems). CONCLUSION This study does not suggest a major effect of fish/fish oil or n-3 fatty acids on the risk of AF.
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Affiliation(s)
- Owais Khawaja
- Division of Aging, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Marchioli R, Levantesi G. Why Do We Still Need Large Scale Clinical Trial: The Case of n-3 PUFA. Front Physiol 2012; 3:202. [PMID: 22754534 PMCID: PMC3385353 DOI: 10.3389/fphys.2012.00202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/22/2012] [Indexed: 01/13/2023] Open
Abstract
After the first reports about a protective effect on coronary heart disease (CHD) published more than 40 years ago, wide interest in the therapeutic use of n-3 polyunsaturated fatty acids (n-3 PUFA) aroused. Since then, many studies and meta-analyses have reported a significantly reduced risk of CHD and CV death due to fish and n-3 PUFA intake. Some of the overviews reported a significant reduction of risk of sudden cardiac death, all-cause death, and nonfatal CV events. On the other side, recent clinical trials had mixed findings, raising concern about the consistency of the evidence on n-3 PUFA. We critically reviewed recent large clinical trials reporting data on the antiarrhythmic effects of n-3 PUFA in different clinical settings, i.e., patients with CHD, heart failure, with implantable cardioverter defibrillator, and at risk of atrial fibrillation, in order to summarize the results which are available up to date and possibly give "substantiated" fuel to the debate on the conflicting results of n-3 PUFA.
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Affiliation(s)
- Roberto Marchioli
- Laboratory of Clinical Epidemiology of Cardiovascular Disease, Consorzio Mario Negri SudChieti, Italy
- Italian Society of Cardiology Research CenterRome, Italy
| | - Giacomo Levantesi
- Laboratory of Clinical Epidemiology of Cardiovascular Disease, Consorzio Mario Negri SudChieti, Italy
- Coronary Care Unit, Cardiologic Department, “S.Pio” Hospital VastoChieti, Italy
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Jenkins DJA, Sievenpiper JL, Chiavaroli L, Mirrahimi A, Kendall CWC. Fish fats and the heart. J Am Coll Nutr 2012; 31:1-3. [PMID: 22661620 DOI: 10.1080/07315724.2012.10720002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Billman GE, Carnes CA, Adamson PB, Vanoli E, Schwartz PJ. Dietary omega-3 fatty acids and susceptibility to ventricular fibrillation: lack of protection and a proarrhythmic effect. Circ Arrhythm Electrophysiol 2012; 5:553-60. [PMID: 22333345 PMCID: PMC3380163 DOI: 10.1161/circep.111.966739] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent clinical studies that evaluated the effects of supplemental omega-3 polyunsaturated fatty acids (n-3 PUFAs) on sudden cardiac death have yielded conflicting results. Our aim was to clarify this issue using an established and clinical relevant canine model of sudden cardiac death. METHODS AND RESULTS Susceptibility to ventricular fibrillation (VF) was evaluated using a 2-minute left circumflex artery occlusion during the last minute of an exercise test in 76 dogs (from 2 independent studies) with healed myocardial infarctions (MI); 44 developed VF (susceptible, VF+), whereas 32 did not (resistant, VF-). These dogs were then randomly assigned to either placebo (1 g/d, corn oil; 15 VF+, 11 VF-) or n-3 PUFA (1-4 g/d, docosahexaenoic acid+eicosapentaenoic acid ethyl esters, 29 VF+, 21 VF-) groups. Seven sham (no-MI) dogs were also treated with n-3 PUFA (4 g/d). After treatment (3 months), the exercise+ischemia test was repeated. Dietary n-3 PUFAs produced significant (P<0.01) increases in red blood cell and left ventricular n-3 PUFA levels. Nine post-MI (5 placebo versus 4 n-3 PUFA) and 2 sham dogs died suddenly during the 3-month treatment period. The n-3 PUFA treatment failed to prevent arrhythmias in VF+ dogs (decreased in 27% placebo versus 24% n-3 PUFA, P=0.5646) but induced VT/VF in VF- animals (n-3 PUFA 33% versus placebo 0%, P=0.0442). CONCLUSIONS Despite large increases in cardiac tissue n-3 PUFA content, dietary n-3 PUFAs did not prevent ischemia-induced VF and actually increased arrhythmia susceptibility in both noninfarcted and low-risk post-MI dogs.
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Affiliation(s)
- George E Billman
- Department of Physiology and Cell Biology, College of Pharmacy, The Ohio State University, Columbus, OH 43210-1218, USA.
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Rauch B, Senges J. The effects of supplementation with omega-3 polyunsaturated Fatty acids on cardiac rhythm: anti-arrhythmic, pro-arrhythmic, both or neither? It depends…. Front Physiol 2012; 3:57. [PMID: 22485090 PMCID: PMC3317266 DOI: 10.3389/fphys.2012.00057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/28/2012] [Indexed: 12/11/2022] Open
Abstract
Supplementation of omega-3 fatty acids (Ω-3) has been associated with a decreased cardiovascular risk, thereby concentrating attention on a potentially preventive effect regarding tachyarrhythmias and sudden cardiac death. However, recent randomized controlled trials challenge the efficacy of the additional application of Ω-3 and its anti-arrhythmic effect under certain clinical conditions. The present paper reflects the results of earlier and recent clinical studies with respect to the individual background conditions that may determine the clinical outcome of Ω-3 supplementation and thereby explain apparently conflicting clinical results. It is concluded that the efficacy of Ω-3 supplementation to prevent cardiac arrhythmias strongly depends on the underlying clinical and pharmacological conditions, a hypothesis that also is supported by data from experimental animal studies and by molecular interactions of Ω-3 at the cellular level.
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Affiliation(s)
- Bernhard Rauch
- Zentrum für Ambulante Rehabilitation am Klinikum der Stadt Ludwigshafen Ludwigshafen am Rhein, Germany
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Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol 2011; 58:2047-67. [PMID: 22051327 DOI: 10.1016/j.jacc.2011.06.063] [Citation(s) in RCA: 1139] [Impact Index Per Article: 87.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 06/08/2011] [Accepted: 06/16/2011] [Indexed: 11/22/2022]
Abstract
We reviewed available evidence for cardiovascular effects of n-3 polyunsaturated fatty acid (PUFA) consumption, focusing on long chain (seafood) n-3 PUFA, including their principal dietary sources, effects on physiological risk factors, potential molecular pathways and bioactive metabolites, effects on specific clinical endpoints, and existing dietary guidelines. Major dietary sources include fatty fish and other seafood. n-3 PUFA consumption lowers plasma triglycerides, resting heart rate, and blood pressure and might also improve myocardial filling and efficiency, lower inflammation, and improve vascular function. Experimental studies demonstrate direct anti-arrhythmic effects, which have been challenging to document in humans. n-3 PUFA affect a myriad of molecular pathways, including alteration of physical and chemical properties of cellular membranes, direct interaction with and modulation of membrane channels and proteins, regulation of gene expression via nuclear receptors and transcription factors, changes in eicosanoid profiles, and conversion of n-3 PUFA to bioactive metabolites. In prospective observational studies and adequately powered randomized clinical trials, benefits of n-3 PUFA seem most consistent for coronary heart disease mortality and sudden cardiac death. Potential effects on other cardiovascular outcomes are less-well-established, including conflicting evidence from observational studies and/or randomized trials for effects on nonfatal myocardial infarction, ischemic stroke, atrial fibrillation, recurrent ventricular arrhythmias, and heart failure. Research gaps include the relative importance of different physiological and molecular mechanisms, precise dose-responses of physiological and clinical effects, whether fish oil provides all the benefits of fish consumption, and clinical effects of plant-derived n-3 PUFA. Overall, current data provide strong concordant evidence that n-3 PUFA are bioactive compounds that reduce risk of cardiac death. National and international guidelines have converged on consistent recommendations for the general population to consume at least 250 mg/day of long-chain n-3 PUFA or at least 2 servings/week of oily fish.
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Trikalinos TA, Moorthy D, Chung M, Yu WW, Lee J, Lichtenstein AH, Lau J. Concordance of randomized and nonrandomized studies was unrelated to translational patterns of two nutrient-disease associations. J Clin Epidemiol 2011; 65:16-29. [PMID: 22047889 DOI: 10.1016/j.jclinepi.2011.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/09/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There are several examples in nutrition of discordance between the results of observational studies and randomized controlled trials (RCTs). We hypothesized that this discordance is attributable to differences in the translational paths of nutrient-disease associations. Translational paths can be assessed using citation analysis. STUDY DESIGN AND SETTING We compared the characteristics of citation networks using examples, where RCTs and observational studies agreed (long-chain n-3 polyunsaturated fatty acids [n-3 PUFA]) or disagreed (vitamin E). We performed systematic reviews in each example, constructed citation networks, and compared them with respect to the number of articles and citation relationships between them, as well as the distribution of articles' hub and authority scores. RESULTS For n-3 PUFA, meta-analyses of 14 RCTs and 10 observational studies both suggested that higher intake was associated with lower cardiovascular mortality. For vitamin E, the meta-analysis of 14 RCTs excluded a clinically significant effect, whereas 14 observational studies reported a significant inverse association. The respective citation networks consisted of 392 (n-3 PUFA) and 351 (vitamin E) articles. No differences between the characteristics of the two networks were identified. There was no evidence that the observational studies predated RCTs in the translational process in either example. CONCLUSION In the two examples, citation network characteristics do not predict concordance in the results of observational studies and RCTs.
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Affiliation(s)
- Thomas A Trikalinos
- Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Box #63, 800 Washington Street, Boston, MA 02111, USA.
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Omega-3 Fatty Acids and Cardiovascular Disease Prevention: Reality or Mirage? CURRENT CARDIOVASCULAR RISK REPORTS 2011. [DOI: 10.1007/s12170-011-0205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Morrissey RP, Czer L, Shah PK. Chronic heart failure: current evidence, challenges to therapy, and future directions. Am J Cardiovasc Drugs 2011; 11:153-71. [PMID: 21619379 DOI: 10.2165/11592090-000000000-00000] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Heart failure (HF) is a complex syndrome characterized by the inability of the heart to maintain a normal cardiac output without elevated intracardiac filling pressures, resulting in signs of pulmonary and peripheral edema and symptoms of dyspnea and fatigue. Central to the management of HF is a multifaceted pharmacological intervention to abate the harmful counter-regulatory effects of neurohormonal activation and avid salt and water retention. Whereas up to 40 years ago HF was managed with diuretics and leaf of digitalis, the cornerstones of therapy for HF patients with systolic dysfunction now include ACE inhibitors or angiotensin II type 1 receptor antagonists (angiotensin receptor blockers), β-adrenoceptor antagonists (β-blockers), and aldosterone antagonists, which have significantly improved survival. However, with the increasing number of beneficial therapies, there are challenges to implementing all of them. Specific cardiomyopathies also merit specific considerations with respect to treatment, and - unfortunately - there is no therapy for HF with preserved left ventricular ejection fraction that has been shown to improve survival. Although mortality has improved in HF, the biggest challenge to treatment lies in addressing the morbidity of this disease, which is now the most common reason for hospital admission in our aged population. As such, there are many therapies that may serve to improve the quality of life of HF patients. Future HF treatment regimens may include direct cellular therapy via hormone and cytokine signaling or cardiac regeneration through growth factors or cell therapy.
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Affiliation(s)
- Ryan P Morrissey
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Padilla H, Michael Gaziano J, Djoussé L. Alcohol consumption and risk of heart failure: a meta-analysis. PHYSICIAN SPORTSMED 2010; 38:84-9. [PMID: 20959700 DOI: 10.3810/psm.2010.10.1812] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure is highly prevalent among older adults and is associated with high treatment costs. Identifying modifiable determinants of heart failure may help in prevention. Alcohol consumption has emerged as a modifiable risk factor for cardiovascular diseases. Although many studies have suggested a positive association between heavy drinking and cardiomyopathy, the association between infrequent or light-to-moderate drinking and heart failure risk has been less conclusive. PURPOSE To examine the relation between various levels of alcohol intake and incident heart failure. METHODS We conducted a meta-analysis of 6 studies obtained through a PubMed literature search. Alcohol drinkers were classified as never, former, and current drinkers of 0.1 to 0.9, 1 to 7, 8 to 14, and > 14 drinks per week. RESULTS Compared with never drinkers, the pooled relative risks were 1.16 (95% confidence interval [CI], 0.90-1.51) for former drinkers, 0.90 (95% CI, 0.83-0.98), 0.80 (95% CI, 0.73-0.88), 0.78 (95% CI, 0.65-0.95), and 0.77 (95% CI, 0.63-0.95) for current drinkers of 0.1 to 0.9, 1 to 7, 8 to 14, and > 14 drinks per week, respectively, in a random effects model. CONCLUSION These data suggest that infrequent and light-to-moderate drinking is associated with a lower risk of heart failure.
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Affiliation(s)
- Heather Padilla
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Bushkin-Bedient S, Carpenter DO. Benefits versus risks associated with consumption of fish and other seafood. REVIEWS ON ENVIRONMENTAL HEALTH 2010; 25:161-191. [PMID: 21038755 DOI: 10.1515/reveh.2010.25.3.161] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Fish provide nutrition for much of the world's population, and when not contaminated with chemicals, fish is a very good food. A major benefit of fish is that they are high in polyunsaturated fatty acids (PUFAs), low in saturated fat, and they contain other critical nutrients. Much of the benefit of fish consumption derives from their high levels of long chain omega-3 PUFAs, which are produced by aquatic microorganisms and bioconcentrate in the aquatic food supply. The PUFAs are essential, in that humans and other vertebrates are not able to synthesize them and therefore must obtain them from the diet. The PUFAs particularly concentrate in the nervous system, alter immune system function reduce serum triglyceride levels and have been reported to reduce the risk of sudden death after a myocardial infarction. But the problem is that most fish have at least some degree of chemical contamination with methylmercury, (which binds to muscle) and/or with persistent organic pollutants such as dioxins, polychlorinated biphenyls, polybrominated diphenyl ethers, chlorinated pesticides (which concentrate in fish fat). These chemicals have adverse effects on nervous system function, modulate the immune system, and are associated with elevations in risk of cardiovascular disease. Thus the question of benefits and risk from fish consumption is complex but very important.
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Affiliation(s)
- Sheila Bushkin-Bedient
- Institute for Health and the Environment, University at Albany, Rensselaer, New York, NY 12144-3429, USA
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Filion KB, El Khoury F, Bielinski M, Schiller I, Dendukuri N, Brophy JM. Omega-3 fatty acids in high-risk cardiovascular patients: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2010; 10:24. [PMID: 20525225 PMCID: PMC2894745 DOI: 10.1186/1471-2261-10-24] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 06/03/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple randomized controlled trials (RCTs) have examined the cardiovascular effects of omega-3 fatty acids and have provided unexplained conflicting results. A meta-analysis of these RCTs to estimate efficacy and safety and potential sources of heterogeneity may be helpful. METHODS The Cochrane library, MEDLINE, and EMBASE were systematically searched to identify all interventional trials of omega-3 fatty acids compared to placebo or usual diet in high-risk cardiovascular patients. The primary outcome was all-cause mortality and secondary outcomes were coronary restenosis following percutaneous coronary intervention and safety. Meta-analyses were carried out using Bayesian random-effects models, and heterogeneity was examined using meta-regression. RESULTS A total of 29 RCTs (n = 35,144) met our inclusion criteria, with 25 reporting mortality and 14 reporting restenosis. Omega-3 fatty acids were not associated with a statistically significant decreased mortality (relative risk [RR] = 0.88, 95% Credible Interval [CrI] = 0.64, 1.03) or with restenosis prevention (RR = 0.89, 95% CrI = 0.72, 1.06), though the probability of some benefit remains high (0.93 and 0.90, respectively). However in meta-regressions, there was a >90% probability that larger studies and those with longer follow-up were associated with smaller benefits. No serious safety issues were identified. CONCLUSIONS Although not reaching conventional statistical significance, the evidence to date suggests that omega-3 fatty acids may result in a modest reduction in mortality and restenosis. However, caution must be exercised in interpreting these benefits as results were attenuated in higher quality studies, suggesting that bias may be at least partially responsible. Additional high quality studies are required to clarify the role of omega-3 fatty acid supplementation for the secondary prevention of cardiovascular disease.
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Alessandra Manerba, Enrico Vizzardi, Marco Metra, Livio Dei. n-3 PUFAs and cardiovascular disease prevention. Future Cardiol 2010; 6:343-50. [DOI: 10.2217/fca.10.19] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Today, there are several observational and experimental studies, especially clinical randomized trials, that have proven the beneficial effects of n-3 polyunsaturated fatty acids (PUFAs). The most compelling evidence for the cardiovascular benefits of n-3 PUFAs comes from studies of primary prevention in patients following myocardial infarction, and most recently, in patients with heart failure. In this review, we analyze the evidence from epidemiologic studies and from large randomized controlled trials showing the benefits of n-3 PUFAs, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in primary and secondary cardiovascular prevention. Further studies are needed to determine optimal dosing and the relative ratio of DHA and EPA that provide maximal cardioprotection.
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Ramadeen A, Laurent G, dos Santos CC, Hu X, Connelly KA, Holub BJ, Mangat I, Dorian P. n-3 Polyunsaturated fatty acids alter expression of fibrotic and hypertrophic genes in a dog model of atrial cardiomyopathy. Heart Rhythm 2010; 7:520-8. [DOI: 10.1016/j.hrthm.2009.12.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022]
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Madsen T, Christensen JH, Thogersen AM, Schmidt EB, Toft E. Intravenous infusion of n-3 polyunsaturated fatty acids and inducibility of ventricular tachycardia in patients with implantable cardioverter defibrillator. Europace 2010; 12:941-6. [DOI: 10.1093/europace/euq085] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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von Schacky C. Omega-3 Index and sudden cardiac death. Nutrients 2010; 2:375-388. [PMID: 22254028 PMCID: PMC3257645 DOI: 10.3390/nu2030375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 03/09/2010] [Accepted: 03/10/2010] [Indexed: 01/12/2023] Open
Abstract
Sudden cardiac death (SCD) is an unresolved health issue, and responsible for 15% of all deaths in Western countries. Epidemiologic evidence, as well as evidence from clinical trials, indicates that increasing intake and high levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) protect from SCD and other major adverse cardiac events. Levels of EPA+DHA are best assessed by the Omega-3 Index, representing the red cell fatty acid content of EPA+DHA. Work is in progress that will further define the value of the Omega-3 Index as a risk factor for SCD, other cardiac events, and as target for treatment with EPA+DHA.
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Affiliation(s)
- Clemens von Schacky
- Preventive Cardiology, Medizinische Klinik and Poliklinik Innenstadt, Ludwig Maximilians University Munich, Ziemssenstr. 1, 80336 Munich, Germany;
- Omegametrix, Am Klopferspitz 19, 82152 Martinsried, Germany;
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Abstract
OBJECTIVE The aim of this case series study was to investigate and report on patients with neuropathic pain who responded to treatment with omega-3 fatty acids. METHODS Methods: Five patients with different underlying diagnoses including cervical radiculopathy, thoracic outlet syndrome, fibromyalgia, carpal tunnel syndrome, burn injury were treated with high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA-DHA). Outcome measures were obtained pretreatment and posttreatment. These included validated surveys (short-form McGill Pain questionnaire, DN4 neuropathic pain scale, Pain Detect Questionnaire), objective clinical tools (Jamar grip strength, Lafayette dynamometry, tender point algometry) and EMG Nerve Conduction studies. RESULTS These patients had clinically significant pain reduction, improved function as documented with both subjective and objective outcome measures up to as much as 19 months after treatment initiation. No serious adverse effects were reported. CONCLUSIONS This first-ever reported case series suggests that omega-3 fatty acids may be of benefit in the management of patients with neuropathic pain. Further investigations with randomized controlled trials in a more specific neuropathic pain population would be warranted.
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Marik PE, Varon J. Omega-3 dietary supplements and the risk of cardiovascular events: a systematic review. Clin Cardiol 2010; 32:365-72. [PMID: 19609891 DOI: 10.1002/clc.20604] [Citation(s) in RCA: 256] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epidemiologic data suggest that omega-3 fatty acids derived from fish oil reduce cardiovascular disease. The clinical benefit of dietary fish oil supplementation in preventing cardiovascular events in both high and low risk patients is unclear. OBJECTIVE To assess whether dietary supplements of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) decrease cardiovascular events across a spectrum of patients. DATA SOURCES MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and citation review of relevant primary and review articles. STUDY SELECTION Prospective, randomized, placebo-controlled clinical trials that evaluated clinical cardiovascular end points (cardiovascular death, sudden death, and nonfatal cardiovascular events) and all-cause mortality in patients randomized to EPA/DHA or placebo. We only included studies that used dietary supplements of EPA/DHA which were administered for at least 1 year. DATA EXTRACTION Data were abstracted on study design, study size, type and dose of omega-3 supplement, cardiovascular events, all-cause mortality, and duration of follow-up. Studies were grouped according to the risk of cardiovascular events (high risk and moderate risk). Meta-analytic techniques were used to analyze the data. DATA SYNTHESIS We identified 11 studies that included a total of 39 044 patients. The studies included patients after recent myocardial infarction, those with an implanted cardioverter defibrillator, and patients with heart failure, peripheral vascular disease, and hypercholesterolemia. The average dose of EPA/DHA was 1.8 +/- 1.2 g/day and the mean duration of follow-up was 2.2 +/- 1.2 years. Dietary supplementation with omega-3 fatty acids significantly reduced the risk of cardiovascular deaths (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.79-0.95, p = 0.002), sudden cardiac death (OR: 0.87, 95% CI: 0.76-0.99, p = 0.04), all-cause mortality (OR: 0.92, 95% CI: 0.85-0.99, p = 0.02), and nonfatal cardiovascular events (OR: 0.92, 95% CI: 0.85-0.99, p = 0.02). The mortality benefit was largely due to the studies which enrolled high risk patients, while the reduction in nonfatal cardiovascular events was noted in the moderate risk patients (secondary prevention only). Meta-regression failed to demonstrate a relationship between the daily dose of omega-3 fatty acid and clinical outcome. CONCLUSIONS Dietary supplementation with omega-3 fatty acids should be considered in the secondary prevention of cardiovascular events.
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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Saravanan P, Bridgewater B, West AL, O'Neill SC, Calder PC, Davidson NC. Omega-3 fatty acid supplementation does not reduce risk of atrial fibrillation after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial. Circ Arrhythm Electrophysiol 2009; 3:46-53. [PMID: 20042769 DOI: 10.1161/circep.109.899633] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Omega-3 polyunsaturated fatty acids (n-3 PUFA) have been reported to reduce the risk of sudden cardiac death presumed to be due to fatal ventricular arrhythmias, but their effect on atrial arrhythmias is unclear. METHODS AND RESULTS Patients (n=108) undergoing coronary artery bypass graft surgery were randomly assigned to receive 2 g/d n-3 PUFA or placebo (olive oil) for at least 5 days before surgery (median, 16 days; range, 12 to 21 days). Phospholipid n-3 PUFA were measured in serum at study entry and at surgery and in right atrial appendage tissue at surgery. Echocardiography was used to assess left ventricular function and left atrial dimensions. Postoperative continuous ECG monitoring (Lifecard CF) for 5 days or until discharge, if earlier, was performed with a daily 12-lead ECG and clinical review if patients remained in the hospital beyond 5 days. Lifecard recordings were analyzed for episodes of atrial fibrillation (AF) > or =30 seconds (primary outcome). Clinical AF, AF burden (% time in AF), hospital stay, and intensive care/high dependency care stay were measured as secondary outcomes. One hundred three patients completed the study (51 in the placebo group and 52 in the n-3 PUFA group). There were no clinically relevant differences in baseline characteristics between groups. n-3 PUFA levels were higher in serum and right atrial tissue in the active treatment group. There was no significant difference between groups in the primary outcome of AF (95% confidence interval [CI], -6% to 30%, P=0.28) in any of the secondary outcomes or in AF-free survival. CONCLUSIONS Omega-3 PUFA do not reduce the risk of AF after coronary artery bypass graft surgery. Clinical Trial Registration- www.ukcrn.org.uk. Identifier: 4437.
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The response to fish oil in patients with heart disease depends on the predominant arrhythmia mechanism. Cardiovasc Drugs Ther 2009; 23:333-4; author reply 335-6. [PMID: 19396533 PMCID: PMC2729978 DOI: 10.1007/s10557-009-6172-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Slagsvold JE, Thorstensen K, Kvitland M, Erixon D, Knagenhjelm N, Mack M, Bjerve KS. Fatty acid desaturase expression in human leucocytes correlates with plasma phospholipid fatty acid status. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 69:496-504. [PMID: 19340699 DOI: 10.1080/00365510902759528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Associations between and changes in plasma phospholipid fatty acid (FA) concentrations and expression of delta 5 desaturase (D5D), delta 6 desaturase (D6D) and delta 9 desaturase (D9D) in leucocytes were investigated both before and during n-3 FA supplementation for 2 weeks in 20 healthy individuals. Participants were divided into two groups depending on fish intake: one fish meal or less per week and no marine FA supplement (Lowfish, n = 9) and more than one fish meal per week and/or daily oral marine FA supplement (Highfish, n = 11). Before starting supplementation (t = 0), concentrations of n-3 FAs were significantly lower in the Lowfish group compared to the Highfish group. During supplementation in both groups, n-3 FAs increased, whereas n-6 FAs decreased. D5D expression was significantly higher in Lowfish compared to Highfish at t = 0. No difference in D6D or D9D expression was observed. D5D expression was inversely correlated with EPA, DPA, DHA and total n-3 FA, and positively correlated with the ratio total n-6 FA/total n-3 FA at t = 0. Expression of D5D in the Lowfish group as well as D6D in both groups significantly decreased relative to the expression at t = 0 during the first day of supplement. PUFA concentration was generally predicted by its precursor FA and D5D or D6D expression. The correlations mentioned disappeared after 2 weeks of supplementation. This indicates that steady-state FA desaturase expression is associated with plasma phospholipid FA composition. Whether leucocyte desaturase expression may have potential as a marker of PUFA status merits further investigation.
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Affiliation(s)
- Jens Erik Slagsvold
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Abstract
The incidence of fatal and non-fatal cardiovascular disease (sudden cardiac death (SCD), myocardial infarction, others) varies, depending on conventional risk factors. However, in Western countries, like the US or Germany, incidences of fatal and non-fatal cardiovascular disease are far higher than in countries like Japan. In the present article, these differences are discussed and related to eicosapentaenoic acid (C20:5omega-3 or C20:5n-3; EPA) and docosahexaenoic acid (C22:6omega-3; DHA). Dietary intake of EPA and DHA and a number of other factors determine levels of EPA and DHA in an individual--best assessed as the omega-3 index, defined as the percentage of EPA and DHA in red cells, and analyzed in a standardized fashion. A review of the literature, expanded by measurements of the omega-3 index, indicates that the risk of sudden cardiac death correlates inversely with the omega-3 index. For persons with an omega-3 index <4%, risk is tenfold, as compared to persons with an omega-3 index >8%. A similar, less-pronounced, correlation exists for non-fatal cardiovascular disease. EPA and DHA have anti-arrhythmic and anti-atherosclerotic mechanisms of action. In large-scale intervention studies, intake of EPA and DHA has been demonstrated to reduce SCD and non-fatal cardiovascular events. Assessing or recommending dietary intake of EPA and DHA does not predict the resulting omega-3 index. Taken together, the omega-3 index is a biomarker to assess a person's content of omega-3 fatty acids, and thus the risk for sudden cardiac death, as well as non-fatal cardiovascular events. EPA and DHA prevent fatal and non-fatal cardiovascular disease and complications of congestive heart failure.
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Affiliation(s)
- Clemens von Schacky
- Preventive Cardiology, Medizinische Clinic and Policlinic Innenstadt, University of Munich, Ziemssensstr. 1, D-80336 Munich, Germany.
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Smith PJ, Blumenthal JA, Babyak MA, Georgiades A, Sherwood A, Sketch MH, Watkins LL. Association between n-3 fatty acid consumption and ventricular ectopy after myocardial infarction. Am J Clin Nutr 2009; 89:1315-20. [PMID: 19321564 PMCID: PMC2676996 DOI: 10.3945/ajcn.2008.26829] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND n-3 (omega-3) Fatty acids are associated with a reduced risk of cardiovascular disease; however, the relation between dietary intake of n-3 fatty acids and ventricular arrhythmias has not been investigated among acute post-myocardial infarction (AMI) patients-a group at elevated risk of malignant arrhythmias. OBJECTIVE The objective was to examine the association between n-3 fatty acid consumption and ventricular ectopy among AMI patients. DESIGN In 260 AMI patients, dietary intake of n-3 fatty acids was assessed by using the Harvard food-frequency questionnaire, and ventricular ectopy was estimated from 24-h electrocardiograph recordings. RESULTS A greater intake of n-3 fatty acids (eicosapentaenoic acid + docosahexaenoic acid + docosapentaenoic acid + alpha-linolenic acid) was associated with lower ventricular ectopy (beta = -0.35, P = 0.011), and this effect remained after cardiovascular comorbidities were controlled for (beta = -0.47, P = 0.003). Higher concentrations of both marine-based (eicosapentaenoic acid + docosahexaenoic acid) (beta = -0.21, P = 0.060) and plant-based (alpha-linolenic acid) (beta = -0.33, P = 0.024) fatty acids remained associated with lower ventricular ectopy after cardiovascular comorbidities were controlled for. CONCLUSION These findings extend existing evidence linking n-3 fatty acid consumption to a reduced risk of ventricular arrhythmias by showing that a greater intake of n-3 fatty acids may be associated with low ventricular ectopy among AMI patients.
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Affiliation(s)
- Patrick J Smith
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University, Durham, NC, USA
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Mangat I. Do vegetarians have to eat fish for optimal cardiovascular protection? Am J Clin Nutr 2009; 89:1597S-1601S. [PMID: 19321560 DOI: 10.3945/ajcn.2009.26736i] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Interest in the cardiovascular protective effects of n-3 (omega-3) fatty acids has continued to evolve during the past 35 y since the original research describing the low cardiovascular event rate in Greenland Inuit was published by Dyerberg et al. Numerous in vitro experiments have shown that n-3 fatty acids may confer this benefit by several mechanisms: they are antiinflammatory, antithrombotic, and antiarrhythmic. The n-3 fatty acids that have received the most attention are those that are derived from a fish source: namely, the longer-chain n-3 fatty acids eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3). More limited data are available on the cardiovascular effects of n-3 fatty acids derived from plants such as alpha-linolenic acid (ALA; 18:3n-3). Observational data suggest that diets rich in EPA, DHA, or ALA do reduce cardiovascular events, including myocardial infarction and sudden cardiac death; however, randomized controlled trial data are somewhat less clear. Several recent meta-analyses have suggested that dietary supplementation with EPA and DHA does not provide additive cardiovascular protection beyond standard care, but the heterogeneity of included studies may reduce the validity of their conclusions. No data exist on the potential therapeutic benefit of EPA, DHA, or ALA supplementation on those individuals who already consume a vegetarian diet. Overall, there is insufficient evidence to recommend n-3 fatty acid supplementation for the purposes of cardiovascular protection; however, ongoing studies such as the Alpha Omega Trial may provide further information.
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Affiliation(s)
- Iqwal Mangat
- Arrhythmia Service, St Michael's Hospital, Toronto, Canada University of Toronto, Toronto, Canada
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Jenkins DJA, Sievenpiper JL, Pauly D, Sumaila UR, Kendall CWC, Mowat FM. Are dietary recommendations for the use of fish oils sustainable? CMAJ 2009; 180:633-7. [PMID: 19289808 PMCID: PMC2653584 DOI: 10.1503/cmaj.081274] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- David J A Jenkins
- Risk Factor Modification Centre, St. Michael's Hospital, and Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ont.
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Brouwer IA, Raitt MH, Dullemeijer C, Kraemer DF, Zock PL, Morris C, Katan MB, Connor WE, Camm JA, Schouten EG, McAnulty J. Effect of fish oil on ventricular tachyarrhythmia in three studies in patients with implantable cardioverter defibrillators. Eur Heart J 2009; 30:820-6. [PMID: 19196720 DOI: 10.1093/eurheartj/ehp003] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To determine the effects of omega-3 polyunsaturated fatty acids (omega-3 PUFAs) from fish on the incidence of recurrent ventricular arrhythmia in implantable cardioverter defibrillator (ICD) patients by combining results from published trials. METHODS AND RESULTS We searched in the Medline, EMBASE, and Cochrane databases and performed a meta-analysis on all three available trials on fish oil and ventricular arrhythmia. Furthermore, we pooled individual data of two of these randomized, double-blind, placebo-controlled trials (Raitt et al. Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial. JAMA 2005;293:2884-2891 and Brouwer et al. Effect of fish oil on ventricular tachyarrhythmia and death in patients with implantable cardioverter defibrillators: the Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) randomized trial. JAMA 2006;295:2613-2619). The main outcome was time to first confirmed ventricular fibrillation (VF) or ventricular tachycardia (VT) combined with death for the meta-analysis, and time to first spontaneous confirmed VF or VT for the pooled analysis. The meta-analysis (n = 1148) showed no convincing protective effect of fish oil (RR 0.90; 95% CI 0.67-1.22). The hazard ratio for the subgroup of patients with coronary artery disease at baseline (0.79; 0.60-1.06) tended towards a protective effect. The pooled analysis (n = 722) showed that time to appropriate ICD intervention was similar for fish oil and placebo treatment (log-rank P = 0.79). CONCLUSION These findings do not support a protective effect of omega-3 PUFAs from fish oil on cardiac arrhythmia in all patients with an ICD. Current data neither prove nor disprove a beneficial or a detrimental effect for subgroups of patients with specific underlying pathologies.
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von Schacky C. Use of red blood cell fatty-acid profiles as biomarkers in cardiac disease. Biomark Med 2009; 3:25-32. [DOI: 10.2217/17520363.3.1.25] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Omega-3 Index is defined as the percentage of eicosapentaenoic acid plus docosahexaenoic acid in red blood cell fatty acids, assessed by a standardized methodology. Better than fatty-acid compositions in other compartments, the Omega-3 Index represents a person’s status in eicosapentaenoic acid plus docosahexaenoic acid. An Omega-3 Index less than 4% is associated with a tenfold risk for sudden cardiac death in comparison to an Omega-3 Index greater than 8%. Mechanisms of action are plausible and large-scale intervention studies in humans support causality. A low Omega-3 Index may also be a risk factor for coronary artery disease and for complications of congestive heart failure. Ongoing research will define the value of the Omega-3 Index as a risk factor and treatment parameter more precisely.
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Affiliation(s)
- Clemens von Schacky
- Preventive Cardiology, Medizinische Klinik & Poliklinik Innenstadt, Ziemssenstr 1, D-80336 München, Germany and, Omegametrix, Am Klopferspitz19, D-82152 Martinsried, Germany
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Græsdal A. Bruk av omega-3-fettsyrer i forebygging av hjertesykdom. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:2109-12. [DOI: 10.4045/tidsskr.08.0447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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León H, Shibata MC, Sivakumaran S, Dorgan M, Chatterley T, Tsuyuki RT. Effect of fish oil on arrhythmias and mortality: systematic review. BMJ 2008; 337:a2931. [PMID: 19106137 PMCID: PMC2612582 DOI: 10.1136/bmj.a2931] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To synthesise the literature on the effects of fish oil-docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)-on mortality and arrhythmias and to explore dose response and formulation effects. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, the Cochrane Library, PubMed, CINAHL, IPA, Web of Science, Scopus, Pascal, Allied and Complementary Medicine, Academic OneFile, ProQuest Dissertations and Theses, Evidence-Based Complementary Medicine, and LILACS. Studies reviewed Randomised controlled trials of fish oil as dietary supplements in humans. DATA EXTRACTION The primary outcomes of interest were the arrhythmic end points of appropriate implantable cardiac defibrillator intervention and sudden cardiac death. The secondary outcomes were all cause mortality and death from cardiac causes. Subgroup analyses included the effect of formulations of EPA and DHA on death from cardiac causes and effects of fish oil in patients with coronary artery disease or myocardial infarction. DATA SYNTHESIS 12 studies totalling 32 779 patients met the inclusion criteria. A neutral effect was reported in three studies (n=1148) for appropriate implantable cardiac defibrillator intervention (odds ratio 0.90, 95% confidence interval 0.55 to 1.46) and in six studies (n=31 111) for sudden cardiac death (0.81, 0.52 to 1.25). 11 studies (n=32 439 and n=32 519) provided data on the effects of fish oil on all cause mortality (0.92, 0.82 to 1.03) and a reduction in deaths from cardiac causes (0.80, 0.69 to 0.92). The dose-response relation for DHA and EPA on reduction in deaths from cardiac causes was not significant. CONCLUSIONS Fish oil supplementation was associated with a significant reduction in deaths from cardiac causes but had no effect on arrhythmias or all cause mortality. Evidence to recommend an optimal formulation of EPA or DHA to reduce these outcomes is insufficient. Fish oils are a heterogeneous product, and the optimal formulations for DHA and EPA remain unclear.
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Affiliation(s)
- Hernando León
- Epidemiology Coordinating and Research (EPICORE) Centre, Edmonton, AB, Canada
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Raitt MH. Are n-3 polyunsaturated fatty acids antiarrhythmic in the absence of ischemia? Editorial to: "The role of n-3 PUFAs in preventing the arrhythmic risk in patients with idiopathic dilated cardiomyopathy" by S. Nodari et al. Cardiovasc Drugs Ther 2008; 23:1-3. [PMID: 19005746 DOI: 10.1007/s10557-008-6151-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 10/24/2008] [Indexed: 11/24/2022]
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Nodari S, Metra M, Milesi G, Manerba A, Cesana BM, Gheorghiade M, Dei Cas L. The role of n-3 PUFAs in preventing the arrhythmic risk in patients with idiopathic dilated cardiomyopathy. Cardiovasc Drugs Ther 2008; 23:5-15. [PMID: 18982439 DOI: 10.1007/s10557-008-6142-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 09/18/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND N-3 polyunsaturated fatty acids (n-3 PUFAs) intake is associated with a reduction in sudden cardiac death in patients with ischemic heart disease. Their effects in patients with heart failure caused by idiopathic dilated cardiomyopathy (IDC) are unknown. METHODS We compared with placebo the effects of n-3 PUFAs administration in 44 patients with IDC and with frequent or repetitive ventricular arrhythmias at Holter monitoring using a randomized, double-blind design. Arrhythmic risk was assessed by microvolt T-wave analysis (MTWA), signal averaged ECG (SAECG), Holter monitoring, power spectral analysis of heart rate (HR) variability, catecholamine and cytokine plasma levels, at baseline and after 6 months. RESULTS At MTWA, 7/12 patients (58%) initially positive became negative after n-3 PUFAs while one patient became positive after placebo (p = 0.019). N-3 PUFAs administration was also associated to normalization of SAECG (11/15 patients, p < 0.0015), decrease in non-sustained ventricular tachycardia (NSVT) episodes (p = 0.0002) and NSVT HR (p = 0.0003), improvement in HR variability and decrease in catecholamine and cytokine plasma levels. The ratio of plasma n-6 PUFAs to n-3 PUFAs decreased from 12.01 to 3.48 after n-3 PUFAs. CONCLUSIONS N-3 PUFAs administration is associated with favorable effects on parameters related to arrhythmic risk in patients with idiopathic dilated cardiomyopathy. These results are consistent with antiarrhythmic activity independent from their antiischemic effects.
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Affiliation(s)
- Savina Nodari
- Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, c/o Spedali Civili, P.zza Spedali Civili, 25100, Brescia, Italy
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Tavazzi L, Maggioni AP, Marchioli R, Barlera S, Franzosi MG, Latini R, Lucci D, Nicolosi GL, Porcu M, Tognoni G. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 2008; 372:1223-30. [PMID: 18757090 DOI: 10.1016/s0140-6736(08)61239-8] [Citation(s) in RCA: 979] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several epidemiological and experimental studies suggest that n-3 polyunsaturated fatty acids (PUFA) can exert favourable effects on atherothrombotic cardiovascular disease, including arrhythmias. We investigated whether n-3 PUFA could improve morbidity and mortality in a large population of patients with symptomatic heart failure of any cause. METHODS We undertook a randomised, double-blind, placebo-controlled trial in 326 cardiology and 31 internal medicine centres in Italy. We enrolled patients with chronic heart failure of New York Heart Association class II-IV, irrespective of cause and left ventricular ejection fraction, and randomly assigned them to n-3 PUFA 1 g daily (n=3494) or placebo (n=3481) by a concealed, computerised telephone randomisation system. Patients were followed up for a median of 3.9 years (IQR 3.0-4.5). Primary endpoints were time to death, and time to death or admission to hospital for cardiovascular reasons. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00336336. FINDINGS We analysed all randomised patients. 955 (27%) patients died from any cause in the n-3 PUFA group and 1014 (29%) in the placebo group (adjusted hazard ratio [HR] 0.91 [95.5% CI 0.833-0.998], p=0.041). 1981 (57%) patients in the n-3 PUFA group and 2053 (59%) in the placebo group died or were admitted to hospital for cardiovascular reasons (adjusted HR 0.92 [99% CI 0.849-0.999], p=0.009). In absolute terms, 56 patients needed to be treated for a median duration of 3.9 years to avoid one death or 44 to avoid one event like death or admission to hospital for cardiovascular reasons. In both groups, gastrointestinal disorders were the most frequent adverse reaction (96 [3%] n-3 PUFA group vs 92 [3%] placebo group). INTERPRETATION A simple and safe treatment with n-3 PUFA can provide a small beneficial advantage in terms of mortality and admission to hospital for cardiovascular reasons in patients with heart failure in a context of usual care.
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Nair GM, Connolly SJ. Should patients with cardiovascular disease take fish oil? CMAJ 2008; 178:181-2. [PMID: 18195293 DOI: 10.1503/cmaj.071654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Girish M Nair
- Division of Cardiology, McMaster University and Hamilton Health Sciences, Hamilton, Ont
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