Fish oils – adjuvant therapy in chronic heart failure?

Abstract

Despite advances in medical management and device therapy, chronic heart failure (CHF) remains a condition of high mortality and poor quality of life. Patients with CHF endure frequent admissions to hospital, with exacerbations of breathlessness or recurrent acute myocardial infarction and have a high incidence of sudden death. A high intake of marine polyunsaturated fatty acids (PUFAs) is associated with lower cardiovascular mortality in the general population, and diabetics, and can reduce cardiovascular deaths post-infarction. Many of the effects of PUFAs could be of benefit in CHF patients. They can improve endothelial function, reduce vascular tone, reduce platelet aggregability, improve myocardial relaxation, stabilize myocardial cells by prolonging the refractory period, and lead to increased appetite and weight gain. They also have potentially important immune-modulating effects, reducing cytokine production and release and altering prostaglandin metabolism. In this review article we discuss the potential benefits of PUFA supplementation in CHF patients using data from clinical trials and in vitro experiments.

Effect of omega-3 on brain natriuretic peptide and echocardiographic findings in heart failure: Double-blind placebo-controlled randomized trial

“…21,22 Other research has reported the antiarrhythmic potential of omega-3 acid ethyl esters, which can prevent recurrent atrial fibrillation in patients with no structural heart disease. 7,18 Fiaccavento et al noted that omega-3 PUFA prolonged survival and inhibited myocardial pathologies in hamsters with cardiomyopathy. 10 To our knowledge no studies have been done to evaluate the effect of omega-3 supplementation on echocardiographic parameters in CHF patients.…”

“…N-3 polyunsaturated fatty acids (PUFA), also known as omega-3 fatty acids, reduce the risk of cardiovascular events in patients with chronic heart conditions. 7 At doses of 3e4 g/day, they are now widely used as lipid-lowering agents that mainly reduce levels of triglycerides. 8 Recently there have been reports of the beneficial effects of PUFA in patients with congestive heart failure (CHF).…”

Effects of fish oil supplementation on inflammatory markers in chronic heart failure: a meta-analysis of randomized controlled trials

“…Fish oil, mainly consisting of two categories of marine omega 3 polyunsaturated fatty acids (PUFAs) - eicosapentaenoic acid (EPA) and ducosahexanoic acid (DHA), has been suggested to be a potential adjunctive therapy for many cardiovascular disorders, including CHF [7,8]. A recent clinical trial [9] showed a statistically significant improved mortality or cardiovascular hospitalizations (-8%; p < 0.01) in patients with CHF who received additional fish oil supplementation.…”

Pericardial delivery of omega-3 fatty acid: a novel approach to reducing myocardial infarct sizes and arrhythmias

“…One potential mechanism for cardiac protection other than the ones already discussed is the bradycardic effect of DHA, which could lower myocardial oxygen consumption during ischemia. In addition, previous cellular studies suggest that n-3 PUFAs could suppress inflammation (7,33), reduce platelet aggregations (38), decrease resultant ischemic oxidative injury (13), and/or inhibit apoptotic signals (12). A recent study reported that, in rabbits, dietary-fed EPA reduced subsequent induced myocardial infarct sizes via the activation of Ca 2ϩ -activated K ϩ channels and nitric oxidemediated mechanisms (24).…”