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The role of omega-3 in the heart

Omega-3, as of late, is only emerging as a supplement that is underutilized in patients with heart disease, hypertension, diabetes, and stroke. New studies have confirmed its use in patients for various purposes.

Maintaining blood pressure

In a double-blind, placebo-controlled RCT, 312 healthy men and women were given a control oil, and fish oil, either at 0.7 or 1.8 grams per day for eight weeks. Fasting blood pressure and laser Doppler iontopheresis was done, to assess microvascular function. For those who took even just 0.7 grams daily, there was a significant reduction by approximately 5 mm Hg in systolic blood pressure, with a p-value 0.046, especially for isolated systolic hypertension. (1)

Reducing triglycerides and very low-density lipoproteins

Triglycerides and very low-density lipoproteins are forms of lipids that have large ratios of saturated fat. These contribute to increased risk of atherosclerosis. In a study, it was found that there is an association with DHA supplementation and decreased VLDL size. Because VLDLs are associated with plasma concentrations of neutrophils and CRP, a decrease in VLDLs caused by DHA may also decrease inflammation.(2)

Another study found that a supplement dose of EPA+DHA totaling 3.4 grams per day lowered triglycerides by 27% compared with a regular nutritional dose of 0.85 grams per day from the usual diet.(3,4)

In a Cochrane review of 1075 diabetics in randomized clinical trials, who were given omega-3 versus placebo, it was concluded that with omega-3 DHA supplementation, there was a significant decrease the levels of triglycerides and very low-density lipoprotein. This would help prevent subsequent strokes and myocardial infarction, especially for those with diabetes.(5)

Reducing the risk of heart disease

In a systematic review of Ovid/Medline, PubMed, Embase, and the Cochrane Library from January 1, 1947, to November 2, 2015, which included 18 RCTs and 16 prospective cohort studies, an analysis on the outcomes of supplementing omega-3 DHA and EPA from either food or capsule form was created. They identified outcomes of myocardial infarction, sudden cardiac death, coronary death, and angina. There was a statistically significant coronary heart disease risk reduction with EPA+DHA provision among high-risk populations, including participants with elevated triglyceride levels and elevated low-density lipoprotein cholesterol.(6)

After myocardial infarction, another study was done to assess post-discharge outcomes after supplementing with 1 gram per day of omega-3. Overall, 11,269 patients met inclusion criteria, of which 2,425 patients (21.5%) were prescribed n-3 PUFA during follow-up. Patients treated with n-3 PUFA tended to be younger, men, and carry a diagnosis of diabetes and were more likely to be receiving guideline-recommended post-AMI medical therapy, including β blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, and antiplatelet therapy (all p <0.001). They adjusted for patient-specific characteristics and concurrent therapies. After twelve months, they found that omega-3 PUFA treatment was associated with reduced all-cause mortality (hazard ratio 0.76, 95% CI 0.59 to 0.97) and recurrent acute myocardial infarction (hazard ratio 0.65, 95% CI 0.49 to 0.87). These results and the large sample size support that omega-3 supplementation may reduce all-cause mortality and recurrent myocardial infarction after a previous MI. (7)

Finding the right omega-3 supplement

Due to the risks of other omega-3 supplements with impurities, it is important to find supplements with a high omega-3 ratio as well as the elimination of environmental pollutants. Safety standards by the European pharmacopeia (EP) and Global Organization of EPA and DHA Omega 3s (GOED) prescribes elimination of arsenic, cadmium, mercury, and lead in fish oil and omega-3 products. They also recommend higher ratios of Omega-3s relative to the rest of the components. One example of a supplement that fits this description is Ultra Omega by Neomega, an omega-3 supplement with 60% essential fatty acids more than the average fish oil capsule (usually at 30%), made in Germany, which can be ordered online in the Philippines. Ultra Omega has EPA 800mg and DHA 400mg per serving, with a recommended serving of 2 capsules a day. It is suggested for consumers to consult their physicians before the use of supplements. Neomega reaches out to give options for health professionals who seek to find more cost-effective options for their patients. Learn more about their Doctor Affiliate Program. They can be reached at www.neomegalife.com, emailed at wecare@neomegalife.com or called at 7275975 or +639177016363.

Disclaimer: This article is produced through Filipino MD staff research. It is sponsored by Neomega Life, a trademark of Omniceutical corp.

References:

(1)Minihane AM, Armah CK, Miles EA, Madden JM, Clark AB, Caslake MJ, Packard CJ, Kofler BM, Lietz G, Curtis PJ, Mathers JC, Williams CM, Calder PC. Consumption of Fish Oil Providing Amounts of Eicosapentaenoic Acid and Docosahexaenoic Acid That Can Be Obtained from the Diet Reduces Blood Pressure in Adults with Systolic Hypertension: A Retrospective Analysis. J Nutr. 2016 Mar;146(3):516-23. doi: 10.3945/jn.115.220475. Epub 2016 Jan 27. https://www.ncbi.nlm.nih.gov/pubmed/26817716
(2)Kelley DS, Siegel D, Fedor DM, Adkins Y, Mackey BE. DHA supplementation decreases serum C-reactive protein and other markers of inflammation in hypertriglyceridemic men. J Nutr. 2009 Mar;139(3):495-501. doi: 10.3945/jn.108.100354. Epub 2009 Jan 21. https://www.ncbi.nlm.nih.gov/pubmed/19158225
(3)Skulas AC, Kris-Etherton PA, Harris WS, Vanden Heuvel JP, Wagner PR, West SG. Dose-response effects of omega-3 fatty acids on triglycerides, inflammation, and endothelial function in healthy persons with moderate hypertriglyceridemia. Am J Clin Nutr February 2011
vol. 93 no. 2 243-252. http://ajcn.nutrition.org/content/93/2/243.full
(4)Kelley DS1, Siegel D, Vemuri M, Mackey BE. Docosahexaenoic acid supplementation improves fasting and postprandial lipid profiles in hypertriglyceridemic men. Am J Clin Nutr. 2007 Aug;86(2):324-33.
https://www.ncbi.nlm.nih.gov/pubmed/17684201
(5)Hartweg J, Perera R, Montori VM, Dinneen SF, Neil AHAWN, Farmer AJ. Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus. 2008. Cochrane. http://www.cochrane.org/CD003205/ENDOC_omega-3-polyunsaturated-fatty-acids-pufa-for-type-2-diabetes-mellitus
(6))Alexander DD, Miller PE, Van Elswyk ME, Kuratko CN, Bylsma LC. Randomized Controlled Trials and Prospective Cohort Studies of Eicosapentaenoic and Docosahexaenoic Long-Chain Omega-3 Fatty Acids and Coronary Heart Disease Risk. 2017. http://dx.doi.org/10.1016/j.mayocp.2016.10.018
(7)Greene SJ1, Temporelli PL2, Campia U3, Vaduganathan M4, Degli Esposti L5, Buda S5, Veronesi C5, Butler J6, Nodari S7. Effects of Polyunsaturated Fatty Acid Treatment on Postdischarge Outcomes After Acute Myocardial Infarction. Am J Cardiol. 2016 Feb 1;117(3):340-6. doi: 10.1016/j.amjcard.2015.10.050. Epub 2015 Nov 18. https://www.ncbi.nlm.nih.gov/pubmed/26708689

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