August 7, 2009
In a state-of-the-art paper scheduled for publication in the August 11, 2009 issue of the Journal of the American College of Cardiology, researchers from Ochsner Medical Center in New Orleans confirm the benefits of omega-3 fatty polyunsaturated fatty acids in reducing cardiovascular disease, events and mortality.
Carl Lavie, MD, FACC, who is the medical director of Cardiac Rehabilitation and Prevention at Ochsner Medical Center, and his associates reviewed data from tens of thousands of patients included in retrospective epidemiologic studies and large randomized controlled trials. According to Dr Lavie and colleagues, the most compelling evidence in favor of omega-3 fatty acids in cardiovascular disease comes from 4 trials of nearly 40,000 participants who received eicosapentaenoic acid (EPA) with or without docosahexaenoic acid (DHA) for primary prevention, following heart attack, and in heart failure. These long-chain omega-3 fatty acids penetrate the cell membrane to help regulate the electrical activity of the heart as well as improve vascular tone, stabilize plaque, and normalize blood pressure.
"This isn't just hype; we now have tremendous and compelling evidence from very large studies, some dating back 20 and 30 years, that demonstrate the protective benefits of omega-3 fish oil in multiple aspects of preventive cardiology," Dr Lavie commented. "The strongest evidence of a cardioprotective effect of omega-3s appears in patients with established cardiovascular disease and following a heart attack with up to a 30 percent reduction in cardiovascular-related death."
A relatively recent controlled trial found a 9 percent reduction in deaths from heart failure among participants who received omega-3 fatty acids compared with those who did not. "If we translate this finding, it means that we only need to treat 56 patients for four years to prevent one death," Dr Lavie noted. "And we are talking about a very safe and relatively inexpensive therapy."
The authors recommend that healthy people consume 500 milligrams EPA plus DHA per day and people with heart disease or heart failure consume up to twice that amount, although many individuals regularly consume higher levels. "There are clear health and heart benefits associated with increasing one's intake of foods that are rich in omega-3s, including oily fish like salmon, sardines, trout, herring, and oysters" Dr. Lavie observed "Patients should talk with their doctors about whether a fish oil supplement is needed to get the right amount and, in turn, benefit from the associated cardiovascular protection."
A healthy heartbeat is stimulated by electrical pulses that arise from within the heart itself, spread throughout the heart in a coordinated pattern, and cause cardiac muscle contractions that send blood pulsing through the body’s network of arteries and veins. Ideally, this system works without problems. When there is a problem with this electrical system, however, an irregular heartbeat, or arrhythmia, may develop.
The main fatty acid in the Western diet is linoleic acid, found mostly in vegetable oils. However, epidemiologic studies many years ago showed that people with a high intake of fatty fish, like the Japanese, have less cardiovascular disease than those who consume Western-type diets (Lee KW et al 2003). Fatty fish, such as mackerel, salmon, herring, sardines, and albacore tuna, and their oils are good sources of long-chain omega-3 polyunsaturated fatty acids (Calder PC et al 2002). The most important omega-3 fatty acids are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which when ingested are immediately available for use in the body.
Extensive scientific studies, both animal and human, have shown that supplementing the diet with fish and their oils has a beneficial effect on the heart, particularly in preventing cardiac arrhythmias (Nair SS et al 1997). The omega-3 fatty acids in fish oils appear to stabilize the electrical activity of the heart muscle, reducing susceptibility even to ventricular arrhythmias and ultimately decreasing the risk of sudden cardiac death (Lee KW et al 2003; Kang JX et al 2000).
The GISSI-Prevention study of more than 11,000 people taking a purified form of omega-3 fatty acids as a supplement has shown a significant decrease in the occurrence of sudden cardiac death among the participants (Lee KW et al 2003; De Caterina R et al 2002; Richter WO 2003). The efficacy of this preparation was greater than that of pravastatin, a commonly prescribed statin drug. Remarkably, the reduction in fatalities was seen even in patients who were already taking preventive medications such as aspirin and statin drugs (Lee KW et al 2003; Richter WO 2003). Beneficial effects may be seen within 90 days of starting omega-3 therapy and may continue progressively with longer use, leading to their recommendation as a “promising additional measure for secondary prevention” (Richter WO 2003).
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