Omega-3 Fatty Acids (cont.)
Dennis Lee, MD
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What are fats, fatty acids, and omega-3 fatty acids?
- What are the benefits of omega-3 fatty acids?
- What is the scientific evidence behind omega-3 fatty acids?
- Recommendations to prevent heart attacks
What are the benefits of omega-3 fatty acids?
Scientific evidence is mounting that fish oil (predominantly omega-3 fatty acids) can reduce the risk of sudden cardiac death. Some scientists also believe that omega-3 fatty acids can improve one's blood lipid (cholesterol and triglyceride) levels and decrease the risk of coronary heart disease.
What is the scientific evidence behind omega-3 fatty acids?
In studies involving animals (dogs, rats, and marmosets), omega-3 fatty acids were found to prevent ventricular fibrillation (see MedicineNet article on heart attack) when given to animals just prior to experimentally induced heart attacks. Omega-3 fatty acids were also found to terminate ventricular fibrillation in animals undergoing experimentally induced heart attacks. Therefore, scientists suspect that omega-3 fatty acids may prevent ventricular fibrillation of the heart in the event of a heart attack in humans. Since ventricular fibrillation is the most important cause of sudden death among heart attack victims, omega-3-fatty acids is believed to prevent sudden death.
Evidence from observational studies: Two large, long-term observational studies have been published on the relationship between dietary intake of fish oil and omega-3 fatty acids and risk of heart disease and sudden cardiac death; The Nurses' Health Study and the Physician's Health Study.
The Physician's Health Study began in 1982 when more than 20,000 healthy male physicians were followed for 11 years. Lifestyle, coronary risk factors, and diet data were collected at entry, and life style and diet data were collected via questionnaires at 12 months and 18 months. The results of the study were published in JAMA 1998, vol. 279, p. 23. The title of the article is "Fish consumption and risk of sudden cardiac death." The study found that men who consumed one or more fish meals per week had a 50% lower risk of developing sudden cardiac death than men who rarely ate fish (less than one fish meal per month).
In a separate article, scientists compared blood levels of omega-3 fatty acids in 94 of these men who died of sudden cardiac death against living men matched for age and smoking habits. They found that high levels of omega-3 fatty acids in the blood were associated with a low risk of cardiac sudden death. Men with the highest blood levels of omega-3 fatty acids had an 80% lower risk of sudden cardiac death than men with the lowest blood levels. High omega-3 fatty acids in the blood are usually due to a high consumption of fish.
The Nurses' Health Study began in 1976 when more than 80,000 female nurses completed life style and diet questionnaires. They were followed for 16 years for the development of coronary heart disease. Omega-3 fatty acid consumption was calculated from the questionnaires. The result of the study was published in JAMA vol 287. No.14, p. 1815. The title of the article is "Fish and omega-3-fatty acid intake and risk of coronary heart disease in women." The study found that compared to women who rarely ate fish (less than one fish meal per month), women who ate fish once a week had a 29% lower risk of developing coronary heart disease. Those who ate fish five times a week had a 34% reduction in the risk of coronary heart disease and a 45% reduction in the risk of death from heart disease (usually sudden cardiac death).
Controlled Studies: Controlled studies are prospective studies that randomly (by chance, e.g., by a flip of a coin) assign subjects to two groups, a treatment group and control group. Subjects in the treatment group are given the medication (or diet) being tested, while the subjects in the control group are usually given an inert substance (placebo).
Two controlled studies on omega-3 fatty acids and fish oil have recently been published. The GISSI-Prevention trial studied the effect of omega-3 fatty acids on sudden death and the recurrence of coronary heart disease in patients who recently survived a heart attack. The Lyon Diet Heart Study studied the effect of a Mediterranean diet (see discussion below) on the recurrence of coronary heart disease in patients who recently survived a heart attack.
The GISSI-Prevention trial randomly assigned more than 11,000 patients with recent heart attacks to four treatment groups; omega-3 fatty acids (850 mg capsule daily), vitamin E, both, or neither (control). The study subjects in all four groups were followed for 3.5 years. Study results were published in Circulation, 2002; 105:1897-1903. Subjects given omega-3 fatty acids had a 20% lower death rate from coronary heart disease than subjects in the vitamin E and control groups. Omega-3 fatty acids were particularly effective in preventing sudden cardiac death (45% reduction in sudden cardiac death). The scientists believed that the benefits of omega-3 fatty acids are in the prevention of ventricular fibrillation. Vitamin E was found to have no benefit compared to controls.
The Lyon Diet Heart Study randomly assigned 600 subjects who survived recent heart attacks to either the Mediterranean diet or a prudent Western diet (diet low in saturated fat and cholesterol). The Mediterranean diet is rich in omega-3 fatty acids, as well as monounsaturated fats, fruits, vegetables, and nuts. The study subjects were followed for 4 years. The results of the study were published in Circulation, 1999; 99:779-785. The subjects eating the Mediterranean diet had more than a 50% reduction in sudden cardiac death and in repeat fatal or nonfatal heart attacks as compared to the Western diet group.
The GISSI-Prevention trial found that omega-3 fatty acids prevented sudden cardiac death, but did not prevent repeat heart attacks. The Lyon Diet Heart Study found that the Mediterranean diet not only prevented sudden cardiac death, but also prevented the recurrence of both fatal and nonfatal heart attacks. The reasons for the difference in the two studies are not clear. Perhaps there are additional cardiac protective factors in the Mediterranean diet.
Tips to keep it under control.