Review on Omega-3 Fatty Acids in Heart Failure
Marchioli et al., Current Atherosclerosis Reports , 11: 440-447, 2009.
Consorzio Mario Negri Sud, Via Nazionale, Imbaro, Italy
Heart failure is a serious medical condition wherein an impairment in heart functioning results in an insufficient delivery of oxygenated blood to meet the body’s needs. It occurs in 2-3 % of the adult population and up to 10 % of those over the age of 60 . It results following a previous heart attack (MI-myocardial infarction), other forms of heart disease, and is associated with hypertension, smoking, obesity, diabetes, and other disorders.
The present article (lead author being Dr. Marchioli who was a key clinical investigator in the well-known GISSI trials) outlines the findings from the GISSI-Heart Failure (GISSI-HF) study and reviews related evidence for the effects of omega-3 fatty acid supplementation (as EPA plus DHA) in relation to heart failure. The large-scale GISSI trial (Lancet, 372: 1223- 1230 (2008)) which tested the effect of supplemental omega-3 in a large population of heart failure patients (average age of 67 years with 78 % being males) randomly assigned 3494 patients to receive 850- 882 mgs of EPA plus DHA daily (45 % as EPA and 55 % as DHA) over a median duration of 3.9 years with a second group ( 3481 controls) receiving a ‘placebo’ supplement. All patients were maintained on their regular medications as prescribed for heart failure. The overall risk of dying or being admitted to hospital for cardiovascular reasons was found to be significantly lower (by 8 %) in those receiving omega-3 supplementation as compared to those receiving the ‘placebo’ lacking EPA/DHA. In the present review, the authors suggest that the favorable effects of the EPA/DHA supplementation are likely via anti-arrhythmic plus other effects (including anti-inflammatory). They also point out that the GISSI-HF trial confirms the ‘safety and extend the efficacy of treatment with n-3 PUFA from post-MI patients to those with chronic HF ’. In another recently-published review of this topic (Marchioli et al., Expert Rev. Cardiovasc. Ther., 7: 735-748 (2009) on n-3 PUFA (n-3 or omega-3 polyunsaturated fatty acids) in heart failure, the authors conclude with the following statement : ‘ A simple and safe treatment with n-3 PUFA provides a beneficial advantage in patients with heart failure in a context of usual care’.
Dr. Holub's Comments:
The present review has focused on the effect of omega-3 supplementation in patients with pre-existing heart failure as clinically diagnosed . It is noted that a major population study of 4,738 older adults (free of heart failure at the beginning) found that those consuming 3-4 fish (non-fried) servings/week or at least 490 mg EPA/DHA daily (average) over a 12-year period had a 30 and 37 % lower risk, respectively, of developing congestive heart failure (Mozaffarian et al., J. Am. College Cardiology, 45:2015-2021 (2005).