title: Exploring newer cardioprotective strategies: ω-3 fatty acids in perspective.
abstract: In the 1980s, observational retrospective studies showed an inverse relation between coronary heart disease (CHD) and consumption of fish containing fatty acids that belong to the omega (ω)-3 family. Large case-control studies and prospective intervention trials consistently showed that ω-3 fatty acids supplementation lowers fatal myocardial infarction (MI) and sudden cardiac death. By analysing the strengths of the results of individual studies and how the meta-analyses agree with them, putting together relevant backgrounds, and identifying open questions, the following findings/directions emerge. (i) Dietary and non-dietary intake of ω-3 fatty acids reduces overall mortality, mortality due to MI, and sudden death in patients with CHD; (ii) Fish oil consumption directly or indirectly affects cardiac electrophysiology. Fish oil reduces heart rate, a major risk factor for sudden death; (iii) Among patients with implantable cardioverter defibrillators, ω-3 fatty acids do not reduce the risk of ventricular tachycardia/ventricular fibrillation and may actually be pro-arrhythmic; (iv) The consumption of ω-3 fatty acids leads to a 10-33% net decrease of triglyceride levels. The effect is dose-dependent, larger in studies with higher mean baseline triglyceride levels, and consistent in different populations (healthy people, people with dyslipidaemia, diabetes, or known cardiovascular risk factors); (v) Outcomes for which a small beneficial effect ω-3 fatty acids is found include blood pressure (about 2 mmHg reduction), re-stenosis rates after coronary angioplasty (14% reduction), and exercise tolerance testing. Major experimental data provide strength (biological plausibility) for these findings, and define directions for newer clinical trials with ω-3 fatty acids.
authors.affiliation: Department of Experimental and Clinical Medicine, Federico II University, Naples, Italy. dario.diminno@hotmail.it
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.forename: Antonella
authors.initials: A
authors.lastname: Tufano
authors.forename: Anna
authors.initials: A
authors.lastname: Russolillo
authors.forename: Roberta
authors.initials: R
authors.lastname: Lupoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Minno
mesh_terms: D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D019317:Evidence-Based Medicine; D015525:Fatty Acids, Omega-3 / Q000494:pharmacology / Q000627:therapeutic use*; D005395:Fish Oils / Q000494:pharmacology / Q000627:therapeutic use*; D006321:Heart / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D015201:Meta-Analysis as Topic; D009203:Myocardial Infarction / Q000517:prevention & control; D014280:Triglycerides / Q000378:metabolism
chemical_list: D002316:Cardiotonic Agents; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D014280:Triglycerides