Omega-3 polyunsaturated fatty acids in cardiology
Abstract
Long-chain omega-3 polyunsaturated fatty acids (ω-3 PUFA): eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) - have some important biological effects that can be used in cardiology. Long-chain omega-3 PUFA intake, in the dose of 3-4 g/d and more, decrease hypertriglyceridemia, thrombogenesis, inflammatory and immune processes, and vascular tonus. Free EPA and DHA act as structural components of cell membranes; they modify –inhibit trans-membrane ion channels; demonstrate antiarrhythmic effects; increase heart rate variability. In GISSI-Prevenzione study, among patients taking omega-3 PUFA, the incidence of combined end-point (total mortality, nonfatal myocardial infarction (MI), and stroke (S)) was lower than that in placebo group, by 15-16% (Р=0.02). Cardiovascular death risk, plus nonfatal MI and S risk, was also lower, comparing to placebo group (-20-21%; Р=0.006). The risk reduction was maximal (-45%; Р=0.0006) for sudden death; its risk was decreased as early as after 4 months of treatment.
About the Author
N. V. Perova
State Research Center for Preventive Medicine, Ministry of Health of the Russian Federation, Moscow
Russian Federation
Russian Federation
References
1. Kromann N, Green A. Epidemiological studies in the Upernavic district Grenland: incidence of some chronic disease 1950-1974. Acta Med Scand 1980; 208: 401-6.
2. Dyeberg J, Band HO, Hjorne N. Fatty acid composition of the plasma lipids in Grenland Eskumos. Am Clin-Nutr 1975; 28: 958-66.
3. Leaf A, Weber PC. Cardiovascular effects of n-3 fatty acids. N Engl J Med 1988; 318(9): 549-57.
4. Tinoco J. Dietary requirements and functions of -linolenic acid in animals. Prog Lipid Res 1982; 21: 1-45.
5. Holman RT. Nutritional and metabolic interrelationships between fatty acids. Fed Proc 1964; 23: 1062-7.
6. Phillipson BE, Rothrock DW, Connor WE, et al. Reduction of plasma lipids, lipoproteins and apoproteins by dietary fish oibs in patients with hypertriglyceridemia N Engl J Med 1985; 312: 1210-6.
7. Sullivan DR, Sanders TA, Trayner IM, et al. Paradoxal elevation of LDL apoprotein B levels in hypertriglyceridaemic patients and normal subjects ingesting fish oil. Atherosclerosis 1986; 61: 129-34.
8. Harris WS. Fish oils and plasma lipid and lipoprotein metabolism in humans: a critical review. J Lipid Res 1989; 30: 785-807.
9. von Schacky C, Fischer S, Weber PC. Long term effects of dietary marine ω-3 fatty acids upon plasma and cellular lipids, platelet function, and eicosanoid formation in humans J Clin Invest 1985; 76: 1626-31.
10. Kang JX, Leaf A. Evidence that free polyunsaturated fatty acids modify Na+ channels by directly binding of the channel proteins. Proc Natl Acad Sci USA 1996; 93: 3542-6.
11. Kromhout D, Bosschieter EB, de Lezenne Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease (Zutphen dietary study). N Engl J Med 1985; 312: 1205-9.
12. Knapp HR, Reily JA, Alessandrini P, et al. In vivo indexes of platelet and vascular function during fish oil administration in patients with atherosclerosis. N Engl J Med 1986; 314: 937-42.
13. Shekele RB, Missel LV, Paul O, et al. Fish consumption and mortality from coronary heart disease. N Engl J Med 1985; 313: 820-4.
14. GISSI – Prevenzione Investigrtors. Dietary Supplementation with ω-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI – Prevenzione trial. Lancet 1999; 384: 447-55.
15. Marchioli R, Barzi F, Bomba E, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction. Circulation 2002; 105(16): 1897-902.
16. Heart Outcomes Prevention Evaluation Study Investigators. Vitamin E supplementation and cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 154-60.
17. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360: 23-33.
18. Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DABT). Lancet 1989; 8666: 757-61.
19. Hu EB, Bronner L, Willet WC, et al. Fish and омега-3 fatty acid intake and risk of coronary heart disease in women. JAMA 2002; 287(14): 1815-21.
20. Albert CM, Campos H, Stampler MJ, et al. Blood PUFAs and the risk of sudden death N Engl J Med 2002; 346: 1113-8.
21. Siscovick DS, Raghunathan TE, King I, et al. Dietary intake and cell membrane levels of long-chain n-3-polyunsaturated fatty acids and risk of primary cardiac arrest. JAMA 1995; 274: 1363-7.
22. Priori SG, Aliot E, Blomstrom-Lundquist C, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J 2001; 22: 1374-450.
23. Rosenberg TH. Fish food to calm the heart. N Engl J Med 2002; 346: 1102-3.
24. Rupp H, Verboom C-N, Jäger B. Saving lives post MI: highly purified omega-3 PUFA for prevention of sudden death. I Clin and Basic Cardiology 2002; 5: 209-11.
25. Weylandt KH, Kang JX, Leaf A. Polyunsaturated fatty acids exert antiarrhythmic actions as free fatty acids rather then in phospholipids. Lipids 1996; 31: 977-82.
26. Рound EM, Kang JX, Leaf A. Partitioning of polyunsaturated fatty acids, which prevent cardiac arrhytmias, into phospholipid cell membrane. J Lipid Res 2001; 42: 346-51.
27. Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology. Heart rate variability standards of measurement, physiological interpretation and clinical use. Circulation 1996; 93: 1043-65.
Review
For citations:
Perova N.V. Omega-3 polyunsaturated fatty acids in cardiology. Cardiovascular Therapy and Prevention. 2005;4(4):101-107. (In Russ.)
Views:
1096
Email this article 
