Omega 3 fatty acids and cardiovascular disease--fishing for a natural treatment

Din, Jehangir; Newby, David E.; Flapan, Andrew D.

doi:10.1136/bmj.328.7430.30

Cited by 349 publications

(218 citation statements)

References 25 publications

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“…On the other hand, putative cardioprotective mechanisms other than triacylglycerol lowering may explain the post-myocardial infarction mortality risk reduction observed in non-diabetic patients in the Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI) Prevenzione trial [43] and the hypercholesterolaemic patients in the Japan Eicosapentaenoic acid Lipid Intervention Study (JELIS) trial [44]. These include anti-arrhythmic, haemostatic and anti-inflammatory effects and blood-pressure lowering [45]. AFORRD showed no change in systolic or diastolic blood pressure, but in our meta-analysis, omega-3 PUFA supplementation decreased diastolic blood pressure by 1.8 mmHg in patients with diabetes, with no effect on systolic blood pressure [18].…”

Section: Discussionmentioning

confidence: 99%

Atorvastatin in Factorial with Omega-3 EE90 Risk Reduction in Diabetes (AFORRD): a randomised controlled trial

et al. 2008

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Aims/hypothesis The aim of the study was to examine the impact of statin or omega-3-acid ethyl esters 90 (omega-3 EE90; omega-3-acid ethyl esters 90 refers to a mixture of ethyl esters of n-3 fatty acids) on estimated cardiovascular disease (CVD) risk in community-based people with type 2 diabetes but without known CVD and not taking lipid-lowering therapy. Methods A central computer randomised 800 patients in 59 UK general practices to atorvastatin (n=401, 20 mg/day) or placebo (n=399) and omega-3 EE90 (n=397, 2 g/day) or placebo (n=403) in a concealed factorial manner. Participants with LDL-cholesterol <2.6 mmol/l, triacylglycerol <1.5 mmol/l and estimated 10-year CVD risk <20% were compared at 4 months.Results Mean (SD) age was 63.5 (11.7) years, HbA 1c 6.9 (1.1) % and known diabetes duration (median [interquartile range]) was 4 (2-8) years. Fifty-seven per cent were men, 90% white and 74% had an estimated 10-year CVD risk ≥20%. Of 732 patients with 4-month data, more allocated atorvastatin (n=371) compared with placebo (n=361) achieved LDLcholesterol <2.6 mmol/l (91% vs 24%, p<0.001) and had estimated 10-year CVD risks <20% (38% vs 26%, p<0.001). No differences were seen between those allocated omega-3 EE90 (n=371) compared with placebo (n=361) for participants achieving triacylglycerol <1.5 mmol/l (65% vs 60%, p=0.18) or estimated 10-year CVD risks <20% (34% vs 30%, p=0.18). There were no side effects of note. Conclusions/interpretation Many community-based diabetic patients without known CVD remain at high CVD risk despite statin treatment and require additional risk-reduction strategies. The impact of omega-3 EE90 on CVD risk will remain uncertain until clinical endpoint trial results are available.

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Section: Discussionmentioning

confidence: 99%

Atorvastatin in Factorial with Omega-3 EE90 Risk Reduction in Diabetes (AFORRD): a randomised controlled trial

et al. 2008

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“…Even minor reductions in fibrinogen levels are potentially clinically important in reducing the risk of atherosclerosis [61], especially as this risk is high in diabetes [62]. It was not possible to pool the results of other reported thrombotic factors to explore the reported hypocoagulating effect of n-3 PUFA [2].…”

Section: Discussionmentioning

confidence: 99%

“…In patients without diabetes n-3 polyunsaturated fatty acid (n-3 PUFA) (also known as omega-3 fatty acids) supplementation has been reported to have a range of potential cardioprotective effects including anti-inflammatory effects, stabilisation of atherosclerotic plaques, anti-thrombotic effects due to the inhibition of platelet aggregation and enhancing fibrinolysis, as well as anti-hypertensive effects [2], and might therefore be expected to confer specific therapeutic benefits in the treatment of type 2 diabetes. There are, however, few available clinical outcome data.…”

Section: Introductionmentioning

confidence: 99%

“…There are, however, few available clinical outcome data. Two prospective cohort studies among women with type 2 diabetes showed the risk of CHD to be much lower among those with high intakes of n-3 PUFA [3,4], but no randomised controlled clinical outcome trials have been reported and the evidence from secondary prevention trials in non-diabetic populations is conflicting [2,3] with a recent meta-analysis casting doubt on the strength of the evidence [5].…”

Section: Introductionmentioning

confidence: 99%

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Meta-analysis of the effects of n-3 polyunsaturated fatty acids on haematological and thrombogenic factors in type 2 diabetes

et al. 2006

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Aim/hypothesis To determine whether marine-derived n-3 polyunsaturated fatty acids (n-3 PUFA) (also known as omega-3 fatty acids) have beneficial effects on haematological and thrombogenic risk markers in addition to dyslipidaemia, in patients with type 2 diabetes. Methods A systematic review and meta-analysis of randomised controlled trials comparing dietary or nondietary intake of n-3 PUFA with placebo in type 2 diabetes was conducted by systematically searching databases from 1966 to February 2006. Changes in C-reactive protein, IL-6, TNF-α, platelet function, fibrinogen, factor VII, von Willebrand factor, endothelial function, heart rate and blood pressure were recorded. Inclusion of studies, data extraction and quality were assessed independently in duplicate. Results Twelve trials involving 847 subjects with a mean treatment duration of 8.5 weeks included sufficient data to permit pooling. Compared with placebo, n-3 PUFA supplementation had a significant effect on two outcomes: reducing the level of diastolic blood pressure (five trials, 248 subjects) by a mean of 1.8 mm Hg (95% CI 0.0-3.6, p=0.05) and increasing factor VII (two trials, 116 subjects) by 24.9% (95% CI 7.2-42.6, p=0.006). There were no significant effects on systolic blood pressure, fibrinogen or heart rate. Conclusions/interpretation These results suggest that, in addition to the recognised effects on dyslipidaemia, n-3 PUFA decreases diastolic blood pressure, and appears to increase factor VII. Larger and more rigorously conducted clinical trials are required to establish conclusively the role of n-3 PUFA in cardiovascular risk markers and clinical outcomes in type 2 diabetes.

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“…Together with linoleic acid (LA, C18:2n-6), LNA is one of the two essential FA in the human diet; LA and LNA cannot be synthesised by the human metabolism. LNA can be desaturated and elongated in the human body to its longer-chain relatives, long-chain n-3 PUFA (LC n-3 PUFA), but the efficiency of this conversion is reduced by high intake levels of LA, which competes more effectively than LNA for desaturation and elongation enzymes because LA is abundantly present in Western diets (1). There is evidence to suggest that the conversion rate of dietary LNA to LC n-3 PUFA is insufficient to achieve adequate levels, even when the LNA intake is increased (2,3).…”

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confidence: 99%

Dietary intakes and food sources of fatty acids for Belgian women, focused on n‐6 and n‐3 polyunsaturated fatty acids

Sioen

Pynaert

Matthys

et al. 2006

Lipids

102

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ABSTRACT:The intake of fat, saturated and monounsaturated FA (SFA and MUFA), and omega-6 and omega-3 PUFA has been estimated in 641 Belgian women (age 18-39 y). Their food intake was recorded using a 2-d food diary. The PUFA included were linoleic (LA), alpha-linolenic (LNA), arachidonic (AA), eicosapentaenoic (EPA), docosapentaenoic (DPA) and docosahexaenoic (DHA) acids. The mean total fat intake corresponded to 34.3% of total energy intake (E). The mean intake of the FA groups corresponded to 13.7%, 13.1%, and 6.0% of E, for SFA, MUFA, and PUFA, respectively. The mean intake of LA was 5.3% of E and of LNA was 0.6% of E, with a mean LA/LNA ratio of 8.7. The mean intake of AA was 0.03% of E. The mean intake of EPA, DPA, and DHA was 0.04%, 0.01%, and 0.06% of E, respectively. According to the Belgian recommendations, the total fat and SFA intake was too high for about three-quarters of the population. The mean LA and overall n-6 PUFA intake corresponded with the recommendation, with part of the population exceeding the upper level. Conversely, the population showed a large deficit for LNA and n-3 PUFA. The major food source for LA and LNA was fats and oils, followed by cereal products. The main sources of long-chain PUFA were fish and seafood, and meat, poultry, and eggs. From a public health perspective, it seems desirable to tackle the problem of low n-3 PUFA intake.Paper no. L9945 in Lipids 41, 415-422 (May 2006).Advances in the knowledge concerning physiological functions of dietary PUFA, in particular omega-3 PUFA, have led to an increased interest in the food sources and the level of dietary intake of these nutrients. Alpha-linolenic acid (LNA, C18:3n-3) is a plant-derived omega-3 FA. Together with linoleic acid (LA, C18:2n-6), LNA is one of the two essential FA in the human diet; LA and LNA cannot be synthesised by the human metabolism. LNA can be desaturated and elongated in the human body to its longer-chain relatives, long-chain n-3 PUFA (LC n-3 PUFA), but the efficiency of this conversion is reduced by high intake levels of LA, which competes more effectively than LNA for desaturation and elongation enzymes because LA is abundantly present in Western diets (1). There is evidence to suggest that the conversion rate of dietary LNA to LC n-3 PUFA is insufficient to achieve adequate levels, even when the LNA intake is increased (2,3). Nevertheless, a British study suggested that women may possess a greater capacity for LNA conversion than men (4,5). LC n-3 PUFA are not synthesised by plants, but they are present in animals and in the marine food chain, EPA (C20:5n-3), docosapentaenoic acid (DPA, C22:5n-3), and DHA (C22:6n-3) being the most abundant in the human diet. It is via planktivorous fishes that LC n-3 PUFA enter the marine food chain and accumulate in seafood (2). Therefore, seafood products are excellent food sources of LC n-3 PUFA. For more than 30 years, a lot of fundamental clinical and epidemiological research work has been done with regard to the relationship between n-3 FA and health, showin...

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Omega 3 fatty acids and cardiovascular disease--fishing for a natural treatment

Cited by 349 publications

References 25 publications

Atorvastatin in Factorial with Omega-3 EE90 Risk Reduction in Diabetes (AFORRD): a randomised controlled trial

Atorvastatin in Factorial with Omega-3 EE90 Risk Reduction in Diabetes (AFORRD): a randomised controlled trial

Meta-analysis of the effects of n-3 polyunsaturated fatty acids on haematological and thrombogenic factors in type 2 diabetes

Dietary intakes and food sources of fatty acids for Belgian women, focused on n‐6 and n‐3 polyunsaturated fatty acids

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