Good Advice (and Evidence) to Consume Omega-3 Fatty Acids for Heart Health
Increased consumption of omega-3 fatty acids, especially long chain polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) to maintain a healthy heart, is recommended by many national expert committees and professional health associations (see DHA-EPA Omega-3 Institute).
Inflammation and atherosclerosis are hallmarks of coronary heart disease. When it comes to limiting the progression of cardiovascular disease, one target for drug manufacturers is lipoprotein associated phospholipase A2 (Lp-PLA2), also known as platelet-activating factor acetylhydrolase (PAF-AH). This enzyme is associated with low density lipoproteins (LDL-C) and secreted by macrophages in atherosclerotic plaques. Based on a meta-analysis of 32 prospective studies, Lp-PLA2 activity and mass showed a correlation of similar magnitude with cardiovascular disease as non-HDL cholesterol and systolic blood pressure (Lp-PLA2 Studies Collaboration, 2010).
In a new publication, Gajos and colleagues report patients (n = 54) with severe atherosclerotic burden (> 70% had multivessel disease) after stent implantation benefit with 1000 mg omega-3 fatty acids (460 mg EPA and 380 mg DHA) daily (vs soybean oil placebo) for 4 weeks. After 1 month, Lp-PLA2 activity was 9.2% lower in the EPA+DHA supplemented group and oxidized LDL tended (p =0.10) to be 12.9% lower. The high baseline Lp-PLA2 activity may have made this population especially responsive to EPA+DHA supplementation.
Unfortunately, neither blood or red blood fatty acid concentrations are reported by Gajos and colleagues so it is difficult to assess compliance or fatty acid status of the participants. However, the study confirms the cardio-protective effects of EPA+DHA supplementation found by Casula and colleagues. Their conclusion from a meta-analysis of 11 clinical trials conducted in patients with existing cardiovascular disease was:
Overall, our results supply evidence that long-term effect of high-dose omega-3 fatty acid supplementation may be beneficial for the onset of cardiac death, sudden death and myocardial infarction among patients with a history of cardiovascular disease.
In summary, whether one has existing cardiovascular disease or not, as expert Dr Bruce Holub advises, closing the ‘EPA+DHA intake gap’ is good for cardiovascular health.
Gajos G, Zalewski J, Mostowik M, Konduracka E, Nessler J, Undas A. Polyunsaturated omega-3 fatty acids reduce lipoprotein associated phospholipase A2 (Lp-PLA2) in patients with stable angina. 2013 Nutr Metab CVD doi:10.1016/j.numecd.2013.09.011
Lipoprotein-associated phospholipase A2 and risk of coronary disease, stroke, and mortality: Collaborative analysis of 32 prospective studies. 2010 Lancet doi:10.1016/S0140-6736(10)60319-4
Gajos G, Rostoff P, Undas A, Piwowarska W. Effects of polyunsaturated omega-3 fatty acids on responsiveness to dual antiplatelet therapy in patients undergoing percutaneous coronary intervention. 2010 J Am Coll Cardiol doi:10.1016/j.jacc.2009.11.080
Casula M, Soranna D, Catapano AL, Corrao G. Long-term effect of high-dose omega-3 fatty acid supplementation for secondary prevention of cardiovascular outcomes: A meta-analysis of randomized, double blind, placebo controlled trials. 2013 Atheroscler Supplements doi:10.1016/S1567-5688(13)70005-9