Clemens von Schacky

Ludwig-Maximilians-University of Munich | LMU · Faculty of Medicine

Abstract available @ DOI https://doi.org/10.1007/s00392-022-02002-5

Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical p...

Zusammenfassung Ein Mangel an ω-3-Fettsäuren ist weltweit verbreitet. Ursache sind u. a. ein zu geringer Fischverzehr sowie rückläufige Gehalte von Eicosapentaensäure (EPA) und Docosahexaensäure (DHA) in Zuchtlachs. Es deutet sich an, dass die Mortalität an COVID-19 durch die Gabe von EPA und DHA reduziert werden kann. Zudem können diese Fettsäuren...

Brain structure and function depend on a constant and sufficient supply with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) by blood. Blood levels of EPA and DHA reflect dietary intake and other variables and are preferably assessed as percentage in erythrocytes with a well-documented and standardized analytical method (HS-Omega-3 Index...

Bei (viszeraler) Adipositas und der häufig damit assoziierten atherogenen Dyslipidämie stehen Lebensstilmassnahmen an allererster Stelle zur kausalen Therapie. Die bekannten Schwierigkeiten bei der Umsetzung können durch interdisziplinäre Zusammenarbeit ebenso wie durch die Verwendung neuer Technologien wie Wearables und Smartphone-Apps heute besse...

Introduction Observational studies have shown a relationship between omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) and depression in adolescents. However, n-3 LCPUFA supplementation studies investigating the potential improvement in depressive feelings in adolescents from the general population are missing. Methods A one-year double-...

Bei (viszeraler) Adipositas und der häufig damit assoziierten atherogenen Dyslipidämie stehen Lebensstilmaßnahmen an allererster Stelle zur kausalen Therapie. Die bekannten Schwierigkeiten bei der Umsetzung können durch interdisziplinäre Zusammenarbeit, ebenso wie durch die Verwendung neuer Technologien wie Wearables und Smartphone-Apps heute bess...

Cysteine is arguably the best-studied biological amino acid, whose thiol group frequently participates in catalysis or ligand binding by proteins. Still, cysteine’s unusual biological distribution has remained mysterious, being strikingly underrepresented in transmembrane domains and on accessible protein surfaces, particularly in aerobic life form...

The omega-3 index, the percentage of EPA plus DHA in erythrocytes (measured by standardised analysis), represents a human body's status in EPA and DHA. An omega-3 index is measured in many laboratories around the world; however, even small differences in analytical methods entail large differences in results. Nevertheless, results are frequently re...

Scientific societies recommend increasing intake of docosahexaenoic acid (DHA) by 200 mg/day during pregnancy. However, individually, clinical events correlate quite strongly with levels of eicosapentaenoic acid (EPA) and DHA in blood, but these levels poorly correlate with amounts ingested. EPA and DHA in erythrocytes (Omega-3 Index) have a low bi...

Efforts to address risk factors with pharmacotherapy constitute one very important pillar in cardiovascular disease prevention. However, numerous factors modify the causality of lipoprotein-associated risk in ASCVD and the vast majority of coronary heart disease(CHD) (80%) and total cardiovascular events (70%) are lifestyle related.17 To meet our p...

Current algorithms for assessing risk of atherosclerotic cardiovascular disease (ASCVD) and, in particular, the reliance on low-density lipoprotein (LDL) cholesterol in conditions where this measurement is discordant with apoB and LDL-particle concentrations fail to identify a sizeable part of the population at high risk for adverse cardiovascular...

Current algorithms for assessing risk of atherosclerotic cardiovascular disease (ASCVD) and, in particular, the reliance on low-density lipoprotein (LDL) cholesterol in conditions where this measurement is discordant with apoB and LDL-particle concentrations fail to identify a sizeable part of the population at high risk for adverse cardiovascular...

FIG. 1. The ectopic adiposity phenotype. Ectopic fat accumulation in the abdominal cavity (visceral fat) and in organs like pericardium, liver, and pancreas (A), and muscle wasting/intramuscular fat accumulation (B) are bidirectionally linked to chronic inflammation (C) and insulin resistance (D), both of which have been linked to conventional and...

FIG. 2. Inflammation and plaque phenotype. When LDLs penetrate the intima of the vessel wall from the lumen, the Lp-PLA2 residing there uses oxLDL as a substrate, hydrolyzing it to Lyso-PC and OxFA.34 Lyso-PC and OxFA act as secondary messengers that stimulate the upregulation of adhesion molecules on the lumen surface, act as chemoattractants for...

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Current algorithms for assessing risk of atherosclerotic cardiovascular disease (ASCVD) and, in particular, the reliance on low-density lipoprotein (LDL) cholesterol in conditions where this measurement is discordant with apoB and LDL-particle concentrations fail to identify a sizeable part of the population at high risk for adverse cardiovascular...

Background Confusion reigns about omega‑3 fatty acids and their effects. Scientific investigations did not appear to clarify the issue. Guidelines and regulatory authorities contradict each other. Objective This article provides clarity by considering not intake but levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocyt...

Background The association of individual omega-3 fatty acids (n-3 FAs) with ischemic stroke remains unclear. Experimental data strongly suggest that n-3 FAs reduce ischemic stroke due to their anti-thrombotic and anti-inflammatory properties. Yet, recent clinical trials yielded mixed results. While marine n-3 FA supplementation (1g/day) did not red...

Die Prävalenz der Demenz ist in den letzten Jahren gestiegen und nimmt mit dem Alter exponentiell zu. In Deutschland sind ca. 1,7 Mio. Menschen betroffen, die jährliche Neuerkrankungsrate wird auf 300 000 geschätzt. Der Begriff Demenz umfasst verschiedene Krankheitsformen mit unterschiedlichen Ätiologien. Dem demenziellen Syndrom des höheren Lebens...

The prevalence of dementias is on the rise, increases exponentially with age and constitutes a major healthcare burden nationally and worldwide. Dementias are clinically heterogeneous and encompass numerous etiologies. Noteworthy, late onset dementias are closely related to vascular and metabolic risk factors in midlife. Cardiometabolic risk factor...

Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent evidence on non-traditional determinants of cardiometabolic health has advanced our understanding of lifestyle–disease interactions. Chronic exposure to environmental stressors like p...

Figure 1. Lifestyle and high-risk atherosclerosis. Lifestyle risk factors influence plaque composition by modulating traditional and novel pathways associated with cardiovascular risk. Red colour indicates initiation of high-risk atherosclerosis, green colour indicates inhibition of high-risk atherosclerosis. FA: fatty acids; T2DM: type 2 diabetes...

Figure 2. Marine n-3 fatty acids and mechanisms related to cardiovascular risk. Mechanistic studies in humans have demonstrated that the marine n-3 fatty acids eicosapentaenoic acid (EPA) and/or docosahexaenoic acid (DHA) reduce serum triglycerides, shift low-density lipoprotein subfractions and reduce ApoB (b), favourably change body composition (...

Zusammenfassung Die Prävalenz der Demenz ist in den letzten Jahren gestiegen und nimmt mit dem Alter exponentiell zu. In Deutschland sind ca. 1,7 Mio. Menschen betroffen, die jährliche Neuerkrankungsrate wird auf 300 000 geschätzt. Der Begriff Demenz umfasst verschiedene Krankheitsformen mit unterschiedlichen Ätiologien. Dem demenziellen Syndrom de...

Background The etiology of degenerative rotator cuff tears is multifactorial but chronic inflammation plays an important role in the pathogenesis. Some polyunsaturated fatty acids (PUFA) can modulate inflammation and marine n-3 (Omega-3) PUFA have anti- inflammatory effects. We hypothesized that the Omega-3 Index is lower in patients with degenerat...

Purpose: Depression is common in adolescents and long-chain polyunsaturated fatty acids (LCPUFA) are suggested to be associated with depression. However, research in adolescents is limited. Furthermore, self-esteem has never been studied in relation to LCPUFA. The objective here was to determine associations of depression and self-esteem with eico...

Long-chain polyunsaturated fatty acids (LCPUFA) are important for brain development and function, maybe especially during adolescence. Observational studies have demonstrated an association between fish consumption (a source of LCPUFA) and cognition in adolescents, but intervention trials are lacking. The goal of the current study was to investigat...

Vitamin D plays an important role in bone health, but dietary intakes are below recommendations. The purpose of this cross-sectional study was to compare perceptions of dietary vitamin adequacy with the biomarker of vitamin D exposure [25(OH)D] in two populations with (USA) and without (Germany) fortification among adults not using dietary suppleme...

Zusammenfassung Bei Athleten, die ihren Körper in besonders starker Weise beanspruchen, erkennt man die vielfältigen Bedeutungen eines hohen ω-3-Indexes ebenso wie Leistungssportler in besonderer Weise von der Höhe ihres ω-3-Index abhängig sind. EPA und DHA, nicht die pflanzliche α-Linolensäure, sind geeignet, den ω-3-Index zu erhöhen. Ein ω-3-Inde...

Background: Several studies have suggested that low levels of omega-3 fatty acids (n-3 PUFAs) including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are associated with cardiovascular risk, major depression, sleep problems, inflammation and other health-related issues. So far, however, erythrocyte PUFA status in Chronic Fatigue Syndro...

Background: Epidemiologic studies on the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in heart failure are scarce, while one large intervention trial demonstrated a modest benefit. Methods: This is a secondary analysis from the Interdisciplinary Network Heart Failure (INH) program. Patients hospitalized for syst...

Background: Cardiovascular disorders (CVD) and major depressive disorder (MDD) are the most frequent diseases worldwide responsible for premature death and disability. Behavioral and immunological variables influence the pathophysiology of both disorders. We therefore determined frequency and severity of MDD in CVD and studied whether MDD without...

As currently defined, the Omega-3 Index comprises eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), but not docosapentaenoic acid (DPA) in erythrocytes. In fish and many fish oils DPA is detectable (along with EPA and DHA), but sources rich in DPA are scarce. Purified DPA is available, and DPA is a precursor of biologically active molecul...

A low Omega-3 Index (O3I) is associated with suboptimal brain functions, measured e.g. as executive functions or reaction time, and others, all specifically important in elite soccer players. The O3I describes the percentage of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocytes. The O3I has been found low in elite athletes....

Background: Omega-3 fatty acids (n - 3 FA) may have blood pressure (BP)-lowering effects in untreated hypertensive and elderly patients. The effect of n - 3 FA on BP in young, healthy adults remains unknown. The Omega-3 Index reliably reflects an individuals' omega-3 status. We hypothesized that the Omega-3 Index is inversely associated with BP le...

Background: Saturated fatty acids are thought to be harmful by increasing the risk for cardiovascular events. Objective: We examined the associations of erythrocyte saturated fatty acids with total and cardiovascular mortality in patients referred for coronary angiography. Methods: Red blood cell saturated fatty acid (RBC SFA) proportions were...

Zusammenfassung Herzinsuffizienz ist der häufigste Grund für Krankenhausaufnahmen in Deutschland. Die beiden Omega-3-Fettsäuren Eicosapentaensäure (EPA) und Docosahexaensäure (DHA) aus Meeresfisch und ähnlichen Quellen, nicht aber die pflanzliche Alpha-Linolensäure, werden in den Leitlinien bei Herzinsuffizienz mit eingeschränkter linksventrikuläre...

Study objectives: Erythrocyte levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (Omega-3 Index) were previously found to be associated with obstructive sleep apnea (OSA) at very low levels (< 5.0%) in only one epidemiologic study. OSA has comorbidities, such as arterial hypertension, heart failure, or major depression, also asso...

Little is known about the relationship between perceptions of nutrient adequacy and biomarkers of nutrition status. This cross-sectional study of U.S. and German adults (n = 200; 18–80 years) compared dietary practices, knowledge, and beliefs of omega-3 fatty acids (O3-FA) with the omega-3 index (O3-I), an erythrocyte-based biomarker associated wit...

This paper summarizes a debate on whether meta-analyses and systematic reviews are decisive in formulating guidelines for dietary fat. Held during the 12th congress of the International Society for the Study of Fatty Acids and Lipids in Stellenbosch, South Africa, September 7, 2016, the debate was hosted by the International Union of Nutritional Sc...

The public health relevance of drug–nutrition interactions is currently highly undervalued and overlooked. This is particularly the case for elderly persons where multi-morbidity and consequently polypharmacy is very common. Vitamins and other micronutrients have central functions in metabolism, and their interactions with drugs may result in clini...

A low Omega-3 Index (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocytes) is associated with cardiac, cerebral, and other health issues. Intake of EPA and DHA, but not of alpha-linolenic acid (ALA), increases the Omega-3 Index. We investigated bioavailability, safety, palatability and tolerability of EPA and DHA in a novel so...

Purpose High, but not low levels of trans-fatty acids (TFA) in erythrocytes are associated with increased mortality. Current erythrocyte TFA levels in Europe are not known. Methods TFA levels in samples submitted by physicians for erythrocyte omega-3 fatty acid analyses are reported, as analysed with a method (HS-Omega-3 Index®) previously used in...

Background Omega-6 polyunsaturated fatty acids (omega-6 PUFA) are recommended in European cardiovascular prevention guidelines. However, individual fatty acids have distinct biological functions and there have been conflicting reports about the association of omega-6 PUFA with cardiovascular risk. Objective Aim of our study was to investigate the...

The consumption of long-chain omega-3 polyunsaturated fatty acids (LCO3-PUFAs) has shown a great variety of beneficial effects, including cardiovascular, metabolic and inflammatory effects, which make them interesting for the postmenopausal woman. Because LCO3-PUFAs could be effective and safe during this period, a panel of experts from the Spanish...

The long-chain marine n–3 fatty acids have been reported to be cardio protective over many years and many mechanisms of action have been proposed. Up through the first decade of the 21st century, nearly all n–3 randomized trials were positive, but beginning in 2010 several trials were published that did not show a benefit of these fatty acids on cl...

Background: The association of polyunsaturated omega-3 and omega-6 fatty acids with mortality has been extensively studied. Far less is known about the association of omega-9 monounsaturated fatty acids (omega-9 MUFA) with mortality. Objective: We aimed to study the association of individual omega-MUFA with all-cause and cardiovascular mortality...

Background: The role of omega-3 fatty acids (n-3 FAs) in recurrent venous thromboembolism (VTE) remains unknown. Objectives: To investigated the association of n-3 FAs with recurrent VTE or total mortality at six months and three years. Methods: N-3 FAs were assessed in 826 patients aged ≥65 years, categorized into low, medium, and high based...

Background: Omega-3 polyunsaturated fatty acids (PUFA) may affect the risk of cognitive decline in older adults. Methods: Cross-sectional analysis was conducted among 720 (50.4% women) participants aged 68-92 years (mean age: 77.6, SD ±6.2) of the population-based KORA-Age study. Eicosapentaenoic acid and docosahexaenoic acid (omega-3 index) wer...

This article contains additional data related to the research article “Omega-3 fatty acids and mortality in patients referred for coronary angiography – The Ludwigshafen Risk and Cardiovascular Health Study” [1]. The data shows characteristics of the Ludwigshafen Risk and Cardiovascular Health (LURIC) study according to tertiles of omega-3 fatty ac...

Die ω-3-Fettsauren EPA und DHA sind von entscheidender Bedeutung fur die optimale Hirnfunktion. Zur Beurteilung der Versorgung mit diesen Fettsauren sind Biomarker wie der HS-Omega-3 Index ® zu bevorzugen. Niedrige Spiegel von EPA und DHA sind u. a. Pradiktoren fur eingeschrankte komplexe Hirnleistungen und psychiatrische Erkrankungen wie ADHS und...

Background and aims: There is an ongoing debate whether omega-3-fatty acids protect from cardiovascular disease mortality. We examined the associations of erythrocyte omega-3 fatty acids with mortality in patients referred for coronary angiography. Methods: Erythrocyte omega-3 fatty acid proportions were measured at baseline in 3259 participants...

Introduction: The influence of n-3 long-chain polyunsaturated fatty acids (LCPUFA) supplementation on brain functioning is debated. Some studies have found positive effects on cognition in children with learning difficulties, elderly people with cognitive impairment and depression scores in depressed individuals. Other studies have found null or n...

Background The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown. Methods In this double-blind trial, we randomly assigned patients with type 2 diabetes and high cardiovascular risk to receive liraglutide or placebo. The primary composite outcome...

Nutrition is complex-and seemingly getting more complicated. Most consumers are familiar with "essential nutrients," e.g., vitamins and minerals, and more recently protein and important amino acids. These essential nutrients have nutrient reference values, referred to as dietary reference intakes (DRIs) developed by consensus committees of scientif...

In contrast to earlier long-chain (LC) omega-3 (i.e. EPA and DHA) investigations, some recent studies have not demonstrated significant effects of EPA and DHA on cardiovascular disease (CVD) outcomes. The neutral findings may have been due to experimental design issues, such as: maintenance on aggressive cardiovascular drug treatment overshadowing...

The impact of omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) on cognition is heavily debated. In the current study, the possible association between omega-3 LCPUFAs in blood and cognitive performance of 266 typically developing adolescents aged 13-15 years is investigated. Baseline data from Food2Learn, a double-blind and randomized place...

Aims: Trans fatty acids (TFAs) are generated by the food industry and also occur naturally in trace amounts in dairy products. For the latter, beneficial health effects have been claimed, while there are numerous reports about TFA of industrial origin being hazardous to human health. Therefore, we aimed to investigate the association of TFA with m...

Limited data exist on consumer beliefs and practices on the role of omega-3 fatty acid and vitamin D dietary supplements and health. For this reason, the Global Health and Nutrition Alliance conducted an online survey in 3 countries (n = 3030; United States = 1022, Germany = 1002, United Kingdom = 1006) of a convenience sample of adults (aged 18–66...

Background: Affective disorders are associated with an increased risk of cardiovascular disease, which, at least partly, appears to be independent of psychopharmacological treatments used to manage these disorders. Reduced heart rate variability (SDNN) and a low Omega-3 Index have been shown to be associated with increased risk for death after myo...

„Eine ausgewogene Ernährung reicht“ – da weder definiert ist, was eine ausgewogene Ernährung ist, noch wozu sie reicht, ist diese vielfach akzeptierte Feststellung nur ein unbelegtes und unbelegbares Dogma. Veränderungen in unserem Lebensstil und in unserer Ernährung haben dazu geführt, dass weite Teile der Bevölkerung niedrige Spiegel von Vitamin...

Introduction Ingestion of long-chain n-3 PUFA effectively lowers serum triacylglycerol (TAG) levels and increases the Omega-3 Index, defined as the% of EPA and DHAin erythrocyte fatty acids. However, it remains unclear whether there is arelationship between the Omega-3 Index increase (ΔO3I increase) and the TAG level decrease (ΔTAG). We hypothesize...

The Omega-3 Index is defined as erythrocyte eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and represents an individual's status in these two marine omega-3 fatty acids. A target range of 8 - 11% has been suggested, because values below predispose to cardiovascular events, especially sudden cardiac death, as well as to suboptimal brain...

European Journal of Clinical Nutrition is a high quality, peer-reviewed journal that covers all aspects of human nutrition.

In cardiology, results of recent large intervention trials with eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplements were neutral. In contrast, in epidemiologic studies, an inverse relation between clinical events and intake of EPA+DHA was found which was steeper for higher levels of EPA+DHA. A standardized way of determining lev...

Eine unzureichende Versorgung mit Eicosapentaen- (EPA) und Docosahexaensaure (DHA) pradisponiert wahrend der gesamten Lebensspanne zu suboptimaler Hirnstruktur und -funktion. Erhoht man die Zufuhr dieser Omega-3-Fettsauren gezielt auf Basis des HS-Omega-3-Index, konnen kognitive Fahigkeiten erhalten bzw. verbessert werden.

Cytochrome P450 (CYP)-dependent metabolites of arachidonic acid (AA) contribute to the regulation of cardiovascular function. CYP enzymes also accept eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) to yield more potent vasodilatory and potentially anti-arrhythmic metabolites, suggesting that the endogenous CYP-eicosanoid profile can be f...

Recent large trials with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the cardiovascular field did not demonstrate a beneficial effect in terms of reductions of clinical endpoints like total mortality, sudden cardiac arrest or other major adverse cardiac events. Pertinent guidelines do not uniformly recommend EPA + DHA for cardiac...

Zusammenfassung Fettsäuren werden in verschiedensten Kompartimenten gemessen, mit den unterschiedlichsten Ergebnissen. Aufgrund der unterschiedlichen Messverfahren differieren Messergebnisse stark, auch wenn im gleichen Kompartiment gemessen wurde. Deshalb konnten die Ergebnisse wissenschaftlicher Fettsäuremessungen für die klinische Routine nicht...

Some sources of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have disappeared from our diet, like brain, because of fears of bovine spongiform encephalitis. Other sources are declining in content, like farmed fish, because fish oil prices rise, and EPA- and DHA-rich fish oil is replaced by other oils, containing little or no EPA and D...