title: Marine omega-3 highly unsaturated fatty acids: From mechanisms to clinical implications in heart failure and arrhythmias.
abstract: Therapeutic implications of marine omega-3 highly unsaturated fatty acids (HUFA) in cardiovascular disease are still discussed controversially. Several clinical trials report divergent findings and thus leave ambiguity on the meaning of oral omega-3 therapy. Potential prognostic indications of HUFA treatment have been predominantly studied in coronary artery disease, sudden cardiac death, ventricular arrhythmias, atrial fibrillation and heart failure of various origin. It is suspected that increased ventricular wall stress is crucially involved in the prognosis of heart failure. Increased wall stress and an unfavorable myocardial remodeling is associated with an increased risk of arrhythmias by stretch-activated membrane ion channels. Integration of HUFA into the microenvironment of cardiomyocyte ion channels lead to allosteric changes and increase the electrical stability. Increased ventricular wall stress appears to be involved in the local myocardial as well as in the hepatic fatty acid metabolism, i.e. a cardio-hepatic syndrome. Influences of an altered endogenous HUFA metabolism and an inverse shift of the fatty acid profile was underrated in the past. A better understanding of these interacting endogenous mechanisms appears to be required for interpreting the findings of recent experimental and clinical studies. The present article critically reviews major studies on basic pathophysiological mechanisms and treatment effects in clinical trials.
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University, Marburg, Germany; Department of Medicine, Cardiology and Angiology, AGAPLESION Evangelisches Krankenhaus Mittelhessen, Gießen, Germany. Electronic address: tobias.glueck@uni-marburg.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Glück
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University, Marburg, Germany. Electronic address: alter@uni-marburg.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Alter
mesh_terms: D000200:Action Potentials; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D006329:Heart Conduction System / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D015640:Ion Channel Gating / Q000187:drug effects; D007473:Ion Channels / Q000378:metabolism; D032383:Myocytes, Cardiac / Q000187:drug effects / Q000378:metabolism; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D015525:Fatty Acids, Omega-3; D007473:Ion Channels
keywords: Arrhythmia; Atherosclerosis; Atrial fibrillation; Coronary artery disease; DHA; EPA; HUFA; Heart failure; ICD; Omega-3; Pericardium; Polyunsaturated fatty acids; SCD; Ventricular wall stress