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Cardiovascular Impact of Nutritional Supplementation With Omega-3 Fatty Acids
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This paper summarizes information regarding omega-3 polyunsaturated fatty acids (PUFAs). At least two servings of fatty fish per week are recommended for patients without clinical atherosclerotic disease. If this cannot be achieved, dietary supplementation with fish oil may be reasonable. PUFA capsules have a role in treatment of hypertriglyceridemia and prevention of cardiovascular events. PUFAs may decrease inflammation, improve plaque composition and stability, and affect cell membranes. According to recent trial data, prescription eicosapentaenoic acid ethyl ester may reduce cardiovascular events.
- Key clinical trial data on PUFAs are presented in this review.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOmega-3 polyunsaturated fatty acids (PUFAs) are a key component of a heart-healthy diet. For patients without clinical atherosclerotic cardiovascular disease, 2 or more servings of fatty fish per week is recommended to obtain adequate intake of omega-3 PUFAs. If this not possible, dietary supplementation with an appropriate fish oil may be reasonable. Supplementation with omega-3 PUFA capsules serves 2 distinct but overlapping roles: treatment of hypertriglyceridemia and prevention of cardiovascular events. Marine-derived omega-3 PUFAs reduce triglycerides and have pleiotropic effects including decreasing inflammation, improving plaque composition and stability, and altering cellular membranes. Clinical trial data have shown inconsistent results with omega-3 PUFAs improving cardiovascular outcomes. In this paper, the authors provide an overview of PUFAs and a summary of key clinical trial data. Recent trial data suggest the use of prescription eicosapentaenoic acid ethyl ester for atherosclerotic cardiovascular disease event reduction in selected populations.
Additional Info
Cardiovascular Impact of Nutritional Supplementation With Omega-3 Fatty Acids: JACC Focus Seminar
J Am Coll Cardiol 2021 Feb 09;77(5)593-608, RL Weinberg, RD Brook, M Rubenfire, KA EagleFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Primary Care
This review article is an excellent compilation of key studies that evaluate the use of omega-3 supplementation for both primary and secondary prevention of cardiovascular disease. A particularly well-written introductory section includes a brief review of the biochemistry of omega-3 agents as well as a summary of presumed mechanisms of benefit. The concluding section on recommendations for the use of omega-3 agents mirrors major medical society recommendations, some of which are handicapped because they predate recent key studies including REDUCE-IT (positive trial with high-dose EPA) and STRENGTH (negative study with high-dose combined EPA and DHA).
Outstanding questions include: 1) Does background dietary intake of omega-3 influence the benefit available from supplementation? 2) What is the optimal EPA/DHA formulation of omega-3 supplements? 3) What is the optimal dose of EPA/DHA? 4) Did the oil used as a “placebo” comparator influence the results of some omega-3 trials? 5) Is the unexpected finding of higher rates of atrial fibrillation noted in recent studies with omega-3 a reproducible finding?
Consequently, currently findings are inconclusive to guide firm recommendations for omega-3 supplementation. For patients who can consume fish, a solid recommendation can be made for intake of 2 weekly servings of high omega-3 fish (eg, salmon, including canned). For individuals at increased risk of cardiovascular disease, especially those who do not consume fish, omega-3 supplementation at doses of 1 to 4 gm/day may be considered, but uncertainty regarding benefit needs to be acknowledged. Perhaps a stronger case for supplementation could be made for those with additional non-cardiac conditions that might be expected to benefit from the anti-inflammatory properties of omega-3s.