Cardiac Benefits of Omega-3 Fatty Acids

Omega-3 Fatty Acids and Heart Failure

Omega-3 fatty acids have the ability to lower the risk of heart failure. One major cause of CHF is myocardial infarction or heart attack which is an irreversible injury to heart muscle. According to a clinical trial reported in the European Heart Journal, moderate intake of fatty fish and marine omega-3 fatty acids caused lower rates of heart failure. Men who ate fatty fish once a week had 12% less chances of developing heart failure compared to those who never ate fatty fish. Men who consumed approximately 0.36 g/day were 33% less likely to develop heart failure than men who consumed little or no marine omega-3 fatty acids (0.15-0.22 g/day). Higher intake offered no additional benefit. Consumption of baked or broiled fish is also associated with reduced risk of incident heart failure; consumption of fried fish was associated with an increased risk of heart failure.

Omega-3 Fatty Acids in Acute Coronary Syndrome

The term ‘acute coronary syndrome’ comprises a range of coronary artery diseases (CADs), including unstable angina, ST-elevation myocardial infarction (STEMI; often termed as “Q-wave myocardial infarction”), and non-STEMI (NSTEMI; often referred to as “non-Q-wave myocardial infarction”). Symptoms of the acute coronary syndrome include chest pain, referred pain, nausea, vomiting, breathlessness (or dyspnea), sweating (or diaphoresis) and lightheadedness. Consumption of high levels of fish oil (more than 1 g/day) for a long time may reduce the risk of nonfatal heart attacks and acute coronary syndrome.

Omega-3 Fatty Acids Increase Good Cholesterol and Lower Triglycerides

Impact of High Triglyceride Levels

Hypertriglyceridemia or high levels of triglycerides (TGs) in blood greatly increase the risk for heart disease.

  • High TG levels are a causative factor for small, dense LDL (cholesterol in low-density lipoproteins or the ′bad′ cholesterol) particles that are more atherogenic than larger LDL particles.
  • High TG levels reduce levels of HDL or ′good′ cholesterol.
  • High TG levels may unfavourably affect the coagulation system and increase the danger of thrombosis (clot formation). An increase in the risk of thrombosis increases the risk of cardiac events.

Omega-3 Fatty Acids and High Triglyceride Levels

Omega-3 fatty acids in fish oils markedly decrease TGs and very low-density lipoprotein (VLDL) levels in blood and help correct other risk factors for heart disease. The hypotriglyceridemic effect of fish oil appears to be caused mainly by blocking the production of VLDL-triglyceride, but an additional, independent effect upon the breakdown of VLDL molecules into simpler ones cannot be ruled out. They also increase HDL cholesterol. A unique effect of omega-3 fatty acids is to hasten the clearance of fat-containing particles from the blood following meals. This remarkable fat-clearing ability has important implications for prevention of heart disease. According to scientists, this rise in blood fat levels following a meal, known as postprandial hyperlipidemia, may be a potent contributor to atherosclerosis and thus to a heart attack.

Omega-3 fatty acids are required in higher doses to reduce elevated TG levels (2-4 g/day). A unique effect of omega-3 fatty acids is to hasten the clearance of fat-containing particles from the blood following meals. This remarkable fat-clearing ability has important implications for prevention of heart disease.

Fish oil supplementation raises HDL cholesterol (HDL-C) concentrations (+3%) and, particularly in patients with hypertriglyceridemia. They also lower the proportion of small dense LDL-C particles. The rise in LDL cholesterol of up to 5% seen with fish oil consumption is due to increase in LDL particle size i.e. LDL-C concentration may slightly increase but without appreciable change in the number of circulating LDL particles. In persons with hypertriglyceridemia that is resistant to treatment, fish oil supplements (more than 3 g/day of DHA and EPA) can lower the serum TGs by as much as 50% or more.

Omega-3 Fatty Acids Lower Blood Pressure

In older persons and those with high BP (or hypertension), fish oil supplementation considerably decreased both systolic (upper reading of BP) and diastolic BP (lower reading of BP). A study has shown a greater fall in both systolic and diastolic BP in men with high BP at risk of heart disease, with fish oil consumption. The men included in the study were assigned to five high-fat (40% of daily energy) and two low-fat (30% of energy) groups. The five high-fat groups were assigned to take either six or 12 fish-oil capsules daily, fish or a combination of fish oil and fish, or placebo capsules. The two low-fat groups took either fish or placebo capsules. Omega-3 fatty acids from fish oils improve BP control and may reduce the long-term continuous rise in BP in patients who had hypertension and who underwent a heart transplant. The study also illustrated a favorable effect of omega-3 fatty acids on kidney function in these patients.

Omega-3 Fatty Acids Normalize Heart Rhythm and Lower Chances of Sudden Death

Death from coronary heart disease (CHD) (heart attack and chest pain) can be due to heart failure, arrhythmias (abnormally fast or slow heart rhythm) or sudden cardiac death (SCD). Most SCD is due to ventricular fibrillation (abnormal irregular rhythm of the heart where the ventricles i.e. lower chambers of the heart, contract in a very rapid, unsynchronized manner ′fluttering′). The risk of death and sudden death is highest in the first months following a heart attack.

One of the most remarkable benefits of fish oils is their ability to prevent sudden death, SCD in particular. They have antiarrhythmic effect i.e. reducing potentially fatal abnormal heart rhythms, or arrhythmias that lead to SCD and thus offer protection against cardiac sudden death. Fish oil is particularly effective in fighting the common but worrying heart arrhythmia known as atrial fibrillation abnormal heart rhythm that involves the two upper chambers or the atria of the heart. This is especially important, as atrial fibrillation increases the risk of stroke.

More than 2,000 men with previous heart attack were studied to examine the life-saving beneficial action of fish oil. Some were advised to regularly eat fish, while others were not asked to do so. The difference in mortality observed between the two groups after two years was dramatic. Men who consumed fish oil twice a week had a 29% lower rate of death than those who did not. According to the researchers, fish oil helped prevent death in these men with a history of heart muscle damage by stopping the abnormal heart rhythms. Another important study showed that regular consumption of fish is associated with a decrease in heart rate in healthy men. In a study, 9,758 men from Lille (France) and Belfast (Ireland) aged 50-59 years with no previous CHD were grouped according to the amount of fish they consumed on a normal basis.

  • 27% ate fish less than once per week
  • 47% ate fish once per week
  • 20% had fish twice per week
  • 6% ate fish more than twice per week

Regular consumption of fish is associated with decreased heart rate in healthy men which lower the chances of sudden death among fish eaters. In men who ate fish less than once per week, the average heartbeat was 67.5 beats/minute, whereas, the average heartbeat was 65.6 beats/minute in men who ate fish more than twice per week. In a small group of patients undergoing cardiac surgery, consumption of fish oil (2 g/day) for at least five days before elective CABG and until the day of discharge from the hospital markedly reduced the incidence of post-operative AF (54.4%) and was associated with a shorter hospital stay. Another study also found an association between fish oil consumption and reduced risk of atrial fibrillation. It has been shown that patients who develop arrhythmias often have low omega-3 fatty acid levels in their blood. This further affirms the usefulness of omega-3 fatty acids supplementation in promoting healthy heart rhythm.

In a group of 84,688 women aged 34-59 years, from the US Nurses′ Health Study, higher consumption of fish and n-3 fatty acids caused fewer deaths. Compared with fish consumption intake of less than once a month, eating fish at least five times a week lessened the risk of overall death by 32%. Compared with the lowest quintile of omega-3 fatty acid intake, the highest quintile was associated with a 25% reduced risk of overall death. The results also suggested that fish consumption is more protective against fatal CHD than nonfatal myocardial infarction. Oily fish consumption was associated with a 34% reduced risk of death due to CHD during 20 years of follow-up compared with no oily fish consumption. Consumption of 15 g/day of lean fish is equal to about 50 mg of omega-3 fatty acids; in contrast, 15 g/day of oily fish provides about 400 mg of omega-3 fatty acids.

The Time-course of Any Benefit Appears Early

In a major clinical study, the GISSI-Prevenzione trial, in patients with recent heart attack, fish oil reduced mortality, entirely due to fewer SCDs. The protective benefits of fish oil were evident after only a few months of supplementation. In this large study of more than 11,000 adults, those who consumed 1,000 mg of EPA and DHA daily (taken as fish oil supplement) had a 42% reduction in SCDs within the three-month period following a heart attack compared to patients who received no omega-3 fatty acids. These life-saving benefits persisted beyond the initial 3-month danger period as evident by a death rate of 8.4% among the participants who had received the fish oil supplement and 9.8% among those who had not received the fish oil supplement by the end of the 42-month follow-up period.

Omega-3 Fatty Acids Prevent Heart Disease

People who eat more fish generally have a lower risk of CAD and death due to heart disease. A large clinical trial, JELIS, examined the effects of EPA on CAD in patients with high cholesterol levels. Some of these patients on statin drugs (to control cholesterol levels in the blood) but with no evidence of CAD were administered EPA, while others were not. The scientists investigated relationships between the occurrence of CAD, the number of CAD risk factors (obesity, hypercholesterolemia, high TG or low HDL-C, diabetes and hypertension) and EPA treatment. In the higher risk group (TG ≥150 mg/dl; HDL-C < 40 mg/dl), EPA treatment prevented the risk of CAD by 53%. In a meta-analysis of studies of 222,364 individuals, the risk of death due to CHD gradually declined in individuals who ate fish one to three times per month, once per week, two to four times per week, or more than four times per week than in those who ate fish less than once per month. The GISSI-Prevenzione Trial showed that the beneficial effects of fish consumption are related to intake of n-3 fatty acids, which have been shown in trials of supplements to decrease subsequent cardiovascular disease.

Omega-3 Fatty Acids Regress Blockages

Omega-3 fatty acids have antiatherosclerotic effect i.e. fish oil consumption may modestly reduce chronic progression of atherosclerosis, commonly referred to as a ‘hardening’ of the blood vessels (arteries). A clinical trial observed modest but statistically significant effects of fish oil supplementation on progression of coronary, but not carotid, atherosclerosis. Patients with CAD who took about 1.5 g of omega-3 fatty acids per day for two years had less progression and more regression of CAD on coronary angiography than did comparable patients who ingested a placebo. These patients also experienced fewer cardiovascular events. Another trial examined the effects of EPA (1.8 g/day for 2.1 years) on the progression of carotid atherosclerosis in 81 Japanese patients with type 2 diabetes. Individuals who were given EPA had less progression of both mean and maximal intimal medial thickness.

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