Mayo Clinic Proceedings Review on Omega-3 for Cardioprotection

March 14, 2008

Reference:

Omega-3 Fatty Acids for Cardioprotection
Lee JH et al. Mayo Clin Proc. 83:324-332, (2008)
Mid-America Heart Institute and the University of Missouri-Kansas City.

Summary:

In the present review, the authors outline results from the three large controlled trials on 32,000 participants overall who were randomized to received either placebo (control) supplementation or supplements providing DHA+EPA. These trials showed overall reductions in cardiovascular events of 19-45 % which the current authors considered to be the most compelling evidence for the cardiovascular benefit provided by omega-3 fatty acids. The intakes from supplementation in the DART trial (in post-myocardial infarction patients) and the GISSI Prevenzione study (post-myocardial infarction patients also) range from 850-900 mg of DHA/EPA combined per day. In the more recent JELLIS trial, patients with hypercholesterolemia on statin therapy were randomly assigned to a placebo or an EPA concentrate at the level of 1800 mg/day. In contrast to the two aforementioned trials, the JELLIS trial was conducted on Japanese subjects who would be expected to have a much higher intake in their basal diet of DHA/EPA than those in the DART and GISSI studies. Thus, the total intake of EPA/DHA in the JELLIS trial would be approximately 2800 mg/day (approximately 900 mg/day in the basal Japanese diet + 1800 mg of EPA/day via supplementation). The authors recommend that patients should consume DHA+EPA and that the target DHA/EPA (combined) consumption levels should be approximately 1 gm/day for those with known coronary heart disease and at least 500 mg/day for those who are without disease. In addition, the authors indicate that two meals of oily fish per week could provide 400-500 mg/day of DHA/EPA and that supplementation with DHA/EPA up to 3-4 gm/day can provide marked triglyceride lowering ranging from 20-50% depending upon the background triglyceride levels and other parameters associated with the patients being so treated. Finally, the authors conclude that combination therapy with omega-3 fatty acids in addition to statin therapy is a safe and effective way to improve lipid levels and cardiovascular prognosis beyond the benefits obtained by statin therapy alone. In the future, blood measures for DHA/EPA could be used to identify patients with sub-optimal levels of circulating omega-3 fatty acids as a guide to individualized therapeutic recommendations.

Dr. Holub's Comments:

This newly-released review article provides an up to date summary of current knowledge on omega-3 fatty acids as DHA/EPA from fish and/or supplementation on cardioprotection- both preventive and for the management of patients with coronary heart disease who may or may not be on statin therapy. It is noteworthy that fatty fish intakes of 5-7 times per week can be expected to produce a daily intake of DHA/EPA (combined) of approximately 700-1000 mg/day on average. For blood triglyceride-lowering with targets of 25-40% reductions (within a 2-4 week period), supplementation will almost always be required to attain these much higher daily intakes. Pharmaconutrition and nutraceutical therapeutics including omega-3 therapeutics for clinical care by the practitioner, in particular when higher dosages of DHA/EPA are employed will require an awareness of potential contraindications for side effects in a very small number of patients (including those on various blood thinners having coagulation times monitored, other conditions which may be relevant).

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