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Fish Oil for Primary and Secondary Prevention of Coronary Heart Disease

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Abstract

Fish consumption and fish oils rich in omega-3 fatty acids were reported to be cardioprotective in both retrospective and prospective studies undertaken over the past two to three decades. In the past several years, there is mounting clinical trial data as well as basic science information supporting the use of fish oil supplements in both primary and secondary cardiovascular prevention. In addition, there appear to be additional benefits to the use of fish oil, including lowering significantly elevated triglyceride levels, preventing atrial fibrillation, reducing mortality rates in congestive heart failure patients, and perhaps stabilizing atherosclerotic plaques. These data have led to specific recommendations for use of omega-3 fatty acids in several cardiovascular areas.

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References

Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance

  1. Harris WS, Kris-Etherton PM, Harris KA: Intakes of long-chain omega-3 fatty acid associated with reduced risk for death from coronary heart disease in healthy adults. Curr Atheroscler Rep 2008, 10:503–509.

    Article  CAS  PubMed  Google Scholar 

  2. Kris-Etherton PM, Harris WS, Appel LJ: Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002, 106:2747–2757.

    Article  PubMed  Google Scholar 

  3. • Lavie CJ, Milani RV, Mehra MR, et al.: Omega-3 polyunsaturated fatty acids and cardiovascular diseases. J Am Coll Cardiol 2009, 54:585–594. This is a particularly comprehensive and practical review of the topic.

    Article  CAS  PubMed  Google Scholar 

  4. Lee JH, O’Keefe JH, Lavie CJ, et al.: Omega3 fatty acids for cardioprotection. Mayo Clin Proc 2008, 83:324–332.

    Article  CAS  PubMed  Google Scholar 

  5. Hoy SM, Keating GM: Omega-3 ethylester concentrate: a review of its use in secondary prevention post-myocardial infarction and the treatment of hypertriglyceridaemia. Drugs 2009, 69:1077–1105.

    Article  CAS  PubMed  Google Scholar 

  6. • Marik PE, Varon J: Omega-3 dietary supplements and the risk of cardiovascular events: a systematic review. Clin Cardiol 2009, 32:365–372. This article provides the most up-to-date meta-analysis of the effects of omega-3 FAs on clinical CHD events.

    Article  PubMed  Google Scholar 

  7. Brenna JT, Salem N Jr, Sinclair AJ, et al.: alpha-Linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans. Prostaglandins Leukot Essent Fatty Acids 2009, 80:85–91.

    Article  CAS  PubMed  Google Scholar 

  8. Harris WS: Alpha linolenic acid—a gift from the land? Circulation 2005, 111:2872–2874.

    Article  PubMed  Google Scholar 

  9. Harris WS, Mozaffarian D, Rimm EB, et al.: Omega-6 fatty acids and risk for cardiovascular disease: a Science Advisory from the American Heart Association Nutrition Committee. Circulation 2009, 119:902–907.

    Article  PubMed  Google Scholar 

  10. El Boustani S, Colette C, Monnier L, et al.: Enteral absorption in man of eicosapentaenoic acid in different chemical forms. Lipids 1987, 22:711–714.

    Google Scholar 

  11. Nordoy A, Barstad L, Connor WE, et al.: Absorption of the n-3 eicosapentaenoic and docosahexaenoic acids as ethyl esters and triglycerides by humans. Am J Clin Nutr 1991, 53:1185–1190.

    CAS  PubMed  Google Scholar 

  12. GISSI-Prevenzione Investigators: Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E in 11,324 patients with myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999, 354:447–455.

    Google Scholar 

  13. Marchioli R, Barzi F, Bomba E, et al.: Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation 2002, 105:1897–1903.

    Article  CAS  PubMed  Google Scholar 

  14. Yokoyama M, Origasa H, Matsuzaki M, et al.: Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007, 369:1090–1098.

    Article  CAS  PubMed  Google Scholar 

  15. GISSI-HF Investigators: 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, 372:1223–1230.

    Google Scholar 

  16. Siscovick DS, Raghunathan TE, King I, et al.: Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. J Am Med Assoc 1995, 274:1363–1367.

    Article  CAS  Google Scholar 

  17. Leaf A, Kang JX: Prevention of cardiac sudden death by N-3 fatty acids: a review of the evidence. J Intern Med 1996, 240:5–12.

    Article  CAS  PubMed  Google Scholar 

  18. GISSI-HF Investigators: Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 2008, 372:1231–1239.

    Google Scholar 

  19. Fonarow GC: Statins and n-3 fatty acid supplementation in heart failure. Lancet 2008, 372:1195–1196.

    Article  PubMed  Google Scholar 

  20. • Matsuzaki M, Yokoyama M, Saito Y, et al.: Incremental effects of eicosapentaenoic acid on cardiovascular events in statin-treated patients with coronary artery disease. Circ J 2009, 73:1283–1290. This is a detailed analysis of the secondary prevention benefits of EPA in the JELIS subgroup population with CAD.

    Article  CAS  PubMed  Google Scholar 

  21. • Tanaka K, Ishikawa Y, Yokoyama M, et al.: Reduction in the recurrence of stroke by eicosapentaenoic acid for hypercholesterolemic patients: subanalysis of the JELIS trial. Stroke 2008, 39:2052–2058. This article documents the safety of omega-3 FAs in regard to stroke and the benefit of secondary prevention in previous stroke patients.

    Article  CAS  PubMed  Google Scholar 

  22. • Saito Y, Yokoyama M, Origasa H, et al.: Effects of EPA on coronary artery disease in hypercholesterolemic patients with multiple risk factors: sub-analysis of primary prevention cases from the Japan EPA Lipid Intervention Study (JELIS). Atherosclerosis 2008, 200:135–140. This is a good analysis of CHD risk factors versus benefit of EPA in the JELIS primary prevention subpopulation, especially the high-triglyceride, low-HDL subgroup.

    Article  CAS  PubMed  Google Scholar 

  23. • Oikawa S, Yokoyama M, Origasa H, et al.: Suppressive effect of EPA on the incidence of coronary events in hypercholesterolemia with impaired glucose metabolism: sub-analysis of the Japan EPA Lipid Intervention Study (JELIS). Atherosclerosis 2009, 206:535–539. This is an analysis looking at the effect of impaired glucose metabolism on risk in the JELIS trial and the benefit of EPA supplementation.

    Article  CAS  PubMed  Google Scholar 

  24. Harris WS, Miller M, Tighe AP, et al.: Omega-3 fatty acids and coronary heart disease risk: clinical and mechanistic perspectives. Atherosclerosis 2008, 197:12–24.

    Article  CAS  PubMed  Google Scholar 

  25. Leaf A, Albert CM, Josephson M, et al.: Prevention of fatal arrhythmias in high-risk subjects by fish oil n-3 fatty acid intake. Circulation 2005, 112:2762–2768.

    Article  CAS  PubMed  Google Scholar 

  26. Metcalf RG, Sanders P, James MJ, et al.: Effect of dietary n-3 polyunsaturated fatty acids on the inducibility of ventricular tachycardia in patients with ischemic cardiomyopathy. Am J Cardiol 2008, 101:758–761.

    Article  CAS  PubMed  Google Scholar 

  27. Calo L, Bianconi L, Colivicchi F, et al.: n-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. J Am Coll Cardiol 2005, 45:1723–1728.

    Article  CAS  PubMed  Google Scholar 

  28. Knapp HR: Dietary fatty acids in human thrombosis and hemostasis. Am J Clin Nutr 1997, 65(suppl):1687S–1698S.

    Google Scholar 

  29. Harris WS: n-3 Fatty acids and serum lipoproteins: human studies. Am J Clin Nutr 1997, 65(suppl):1645S–1654S.

    Google Scholar 

  30. Chin JP, Dart AM: How do fish oils affect vascular function? Clin Exp Pharmacol Physiol 1995, 22:71–81.

    Article  CAS  PubMed  Google Scholar 

  31. Thies F, Garry JM, Yaqoob P, et al.: Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controlled trial. Lancet 2003, 361:477–485.

    Article  CAS  PubMed  Google Scholar 

  32. Geleijnse JM, Giltay EJ, Grobbee DE, et al.: Blood pressure response to fish oil supplementation: meta-regression analysis of randomized trials. J Hypertens 2002, 20:1493–1499.

    Article  CAS  PubMed  Google Scholar 

  33. Mozaffarian D, Geelen A, Brouwer IA, et al.: Effect of fish oil on heart rate in humans: a meta-analysis of randomized controlled trials. Circulation 2005, 112:1945–1952.

    Article  CAS  PubMed  Google Scholar 

  34. Nishimoto T, Pellizzon MA, Aihara M, et al.: Fish oil promotes macrophage reverse cholesterol transport in mice. Arterioscler Thromb Vasc Biol 2009, 29:1502–1508.

    Article  CAS  PubMed  Google Scholar 

  35. Harris WS, Bulchandani D: Why do omega-3 fatty acids lower serum triglycerides? Curr Opin Lipidol 2006, 17:387–393.

    Article  CAS  PubMed  Google Scholar 

  36. Davidson MH: Mechanisms for the hypotriglyceridemic effect of marine omega-3 fatty acids. Am J Cardiol 2006, 98:27i–33i.

    Article  CAS  PubMed  Google Scholar 

  37. Davidson MH, Stein EA, Bays HE, et al.: Efficacy and tolerability of adding prescription omega-3 fatty acids 4 g/d to simvastatin 40 mg/d in hypertriglyceridemic patients: an 8-week, randomized, double-blind, placebo-controlled study. Clin Ther 2007, 29:1354–1367.

    Article  CAS  PubMed  Google Scholar 

  38. Pratt CM, Reiffel JA, Ellenbogen KA, et al.: Efficacy and safety of prescription omega-3-acid ethyl esters for the prevention of recurrent symptomatic atrial fibrillation: a prospective study. Am Heart J 2009, 158:163–169.

    Article  CAS  PubMed  Google Scholar 

  39. Macchia A, Varini S, Grancelli H, et al.: The rationale and design of the FORomegaARD Trial: a randomized, double-blind, placebo-controlled, independent study to test the efficacy of n-3 PUFA for the maintenance of normal sinus rhythm in patients with previous atrial fibrillation. Am Heart J 2009, 157:423–427.

    Article  CAS  PubMed  Google Scholar 

  40. Raitt MH, Connor WE, Morris C, 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.

    Article  CAS  PubMed  Google Scholar 

  41. Brouwer IA, Zock PL, Camm AJ, 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.

    Article  CAS  PubMed  Google Scholar 

  42. Mozaffarian D, Rimm EB: Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA 2006, 296:1885–1899.

    Article  CAS  PubMed  Google Scholar 

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Disclosure

Dr. Harris is a scientific advisor to GlaxoSmithKline, Monsanto, and Unilever; a speaker for GlaxoSmithKline; and the owner of OmegaQuant Analytics, a company that offers blood omega-3 testing. No other potential conflicts of interest relevant to this article were reported.

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Correspondence to Eli M. Roth.

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Roth, E.M., Harris, W.S. Fish Oil for Primary and Secondary Prevention of Coronary Heart Disease. Curr Atheroscler Rep 12, 66–72 (2010). https://doi.org/10.1007/s11883-009-0079-6

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