The Role of n-3 PUFAs in Preventing the Arrhythmic Risk in Patients with Idiopathic Dilated Cardiomyopathy

ArticleinCardiovascular Drugs and Therapy 23(1):5-15 · November 2008with32 Reads
DOI: 10.1007/s10557-008-6142-7 · Source: PubMed
Abstract
N-3 polyunsaturated fatty acids (n-3 PUFAs) intake is associated with a reduction in sudden cardiac death in patients with ischemic heart disease. Their effects in patients with heart failure caused by idiopathic dilated cardiomyopathy (IDC) are unknown. We compared with placebo the effects of n-3 PUFAs administration in 44 patients with IDC and with frequent or repetitive ventricular arrhythmias at Holter monitoring using a randomized, double-blind design. Arrhythmic risk was assessed by microvolt T-wave analysis (MTWA), signal averaged ECG (SAECG), Holter monitoring, power spectral analysis of heart rate (HR) variability, catecholamine and cytokine plasma levels, at baseline and after 6 months. At MTWA, 7/12 patients (58%) initially positive became negative after n-3 PUFAs while one patient became positive after placebo (p = 0.019). N-3 PUFAs administration was also associated to normalization of SAECG (11/15 patients, p < 0.0015), decrease in non-sustained ventricular tachycardia (NSVT) episodes (p = 0.0002) and NSVT HR (p = 0.0003), improvement in HR variability and decrease in catecholamine and cytokine plasma levels. The ratio of plasma n-6 PUFAs to n-3 PUFAs decreased from 12.01 to 3.48 after n-3 PUFAs. N-3 PUFAs administration is associated with favorable effects on parameters related to arrhythmic risk in patients with idiopathic dilated cardiomyopathy. These results are consistent with antiarrhythmic activity independent from their antiischemic effects.
    • "The health benefits associated with intake of marine n-3 PUFA is best documented in the prevention of cardiovascular disease12345678. The preventive role is explained by their ability to lower plasma triacylglycerol (TAG)91011, reduce platelet aggregation [12,13] and blood pressure [14], protect against cardiac arrhythmias [15], and potentially reduce inflammation161718. Recent scientific works also focus on the effect of marine proteins as potentially important components for human health192021. "
    [Show abstract] [Hide abstract] ABSTRACT: Dietary intake of marine omega-3 polyunsaturated fatty acids (n-3 PUFAs) can change the plasma profile from atherogenic to cardioprotective. In addition, there is growing evidence that proteins of marine origin may have health benefits. We investigated a phospholipid-protein complex (PPC) from krill that is hypothesized to influence lipid metabolism, inflammation, and redox status. Male Wistar rats were fed a control diet (2% soy oil, 8% lard, 20% casein), or diets where corresponding amounts of casein and lard were replaced with PPC at 3%, 6%, or 11% (wt %), for four weeks. Dietary supplementation with PPC resulted in significantly lower levels of plasma triacylglycerols in the 11% PPC-fed group, probably due to reduced hepatic lipogenesis. Plasma cholesterol levels were also reduced at the highest dose of PPC. In addition, the plasma and liver content of n-3 PUFAs increased while n-6 PUFAs decreased. This was associated with increased total antioxidant capacity in plasma and increased liver gene expression of mitochondrial superoxide dismutase (Sod2). Finally, a reduced plasma level of the inflammatory mediator interleukin-2 (IL-2) was detected in the PPC-fed animals. The present data show that PPC has lipid-lowering effects in rats, and may modulate risk factors related to cardiovascular disease progression.
    Full-text · Article · Jul 2015
    • "By data transformation, the bias caused by skew of data on raw scale was eliminated in our present study. Thirdly, of the 7 studies [20,71,77,78,123124125 included in the meta-analysis by Xin et al., 3 studies were not included into our present study123124125. Reasons for exclusion were as follows. "
    [Show abstract] [Hide abstract] ABSTRACT: Previous studies did not draw a consistent conclusion about the effects of marine-derived n-3 polyunsaturated fatty acids (PUFAs) on fasting blood level of C-reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α). A comprehensive search of Web of Science, PubMed, Embase and Medline (from 1950 to 2013) and bibliographies of relevant articles was undertaken. Sixty-eight RCTs with a total of 4601 subjects were included in the meta-analysis. Marine-derived n-3 PUFAs supplementation showed a lowering effect on Marine-derived n-3 PUFAs supplementation had a significant lowering effect on TNF-α, IL-6 and CRP in three groups of subjects (subjects with chronic non-autoimmune disease, subjects with chronic autoimmune disease and healthy subjects). A significant negative linear relationship between duration and effect size of marine-derived n-3 PUFAs supplementation on fasting blood levels of TNF-α and IL-6 in subjects with chronic non-autoimmune disease was observed, indicating that longer duration of supplementation could lead to a greater lowering effect. A similar linear relationship was also observed for IL-6 levels in healthy subjects. Restricted cubic spline analysis and subgroup analysis showed that the lowering effect of marine-derived n-3 PUFAs on CRP, IL-6 and TNF-α in subjects with chronic non-autoimmune disease became weakened when body mass index was greater than 30 kg/m(2). The effect of marine-derived n-3 PUFAs from dietary intake was only assessed in subjects with chronic non-autoimmune disease, and a significant lowering effect was observed on IL-6, but not on CRP and TNF-α. Marine-derived n-3 PUFAs supplementation had a significant lowering effect on CRP, IL-6 and TNF-α level. The lowering effect was most effective in non-obese subjects and consecutive long-term supplementation was recommended.
    Full-text · Article · Feb 2014
    • "Triggered activity also could be inhibited in pig cardiomyocytes (Den Ruijter HM et al. 2006). In keeping with these experimental results Ω-3 were effective in reducing the arrhythmic risk in patients with idiopathic dilated cardiomyopathy (Nodari S et al. 2009). "
    Full-text · Chapter · Jan 2014 · Critical reviews in food science and nutrition
    • "Triggered activity also could be inhibited in pig cardiomyocytes (Den Ruijter HM et al. 2006). In keeping with these experimental results Ω-3 were effective in reducing the arrhythmic risk in patients with idiopathic dilated cardiomyopathy (Nodari S et al. 2009). "
    Full-text · Chapter · Jan 2014 · Critical reviews in food science and nutrition
    • "The ω-3 PUFAs provide a wide range of benefits (Table 3) from general improvements in health to protection against inflammation and disease. DHA and EPA have been used in a number of small clinical trials to understand their efficacy Lowers insulin resistance ALA Human (Vuksan et al., 2007) Reduces atherosclerosis DHA, EPA Human (Dyerberg et al., 2004) Aids neural and brain development ALA, DHA Human, rodents, other primates (Lauritzen et al., 2000; McCann and Ames, 2005) Anti-tumor DHA Human, rat (Conklin, 2002; Holian and Nelson, 1992) Prevents apoptosis DHA, EPA Rat (Calviello et al., 1999; German et al., 2006) Prevents inflammation ALA Mouse, rat (Ren et al., 2007) Improves bone density DHA Human (Hogstrom et al., 2007) Alleviates inflammation in cystic fibrosis DHA, EPA Human (De Vizia et al., 2003) Combats oxidative stress DHA Cat, dog, human (Brown, 2008; Yavin et al., 2002) Anti-thrombosis EPA Human (Tamura et al., 1992) Anti-arrhythmia DHA, EPA Human (Lombardi and Terranova, 2007; Nodari et al., 2009) Immuno-modulation DHA, EPA Human (Yaqoob and Calder, 2007) Augments neural, vision, and brain functions DHA, EPA Human (Chen et al., 2008; German et al., 2006; Lauritzen et al., 2000; Valentine and Valentine, 2004) Mitigates fatality from cardiovascular disease DHA, EPA Human (GISSI, 1999) Note: ALA, alpha-linolenic acid, EPA, eicosapentaenoic acid; DHA, docosahexaenoic acid. "
    [Show abstract] [Hide abstract] ABSTRACT: A $600 million nutritional supplements market growing at 30% every year attests to consumer awareness of, and interests in, health benefits attributed to these supplements. For over 80 years the importance of polyunsaturated fatty acid (PUFA) consumption for human health has been established. The FDA recently approved the use of ω-3 PUFAs in supplements. Additionally, the market for ω-3 PUFA ingredients grew by 24.3% last year, which affirms their popularity and public awareness of their benefits. PUFAs are essential for normal human growth; however, only minor quantities of the beneficial ω-3 PUFAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are synthesized by human metabolism. Rather PUFAs are obtained via dietary or nutritional supplementation and modified into other beneficial metabolites. A vast literature base is available on the health benefits and biological roles of ω-3 PUFAs and their metabolism; however, information on their dietary sources and palatability of foods incorporated with ω-3 PUFAs is limited. DHA and EPA are added to many foods that are commercially available, such as infant and pet formulae, and they are also supplemented in animal feed to incorporate them in consumer dairy, meat, and poultry products. The chief sources of EPA and DHA are fish oils or purified preparations from microalgae, which when added to foods, impart a fishy flavor that is considered unacceptable. This fishy flavor is completely eliminated by extensively purifying preparations of n-3 PUFA sources. While n-3 PUFA lipid autoxidation is considered the main cause of fishy flavor, the individual oxidation products identified thus far, such as unsaturated carbonyls, do not appear to contribute to fishy flavor or odor. Alternatively, various compound classes such as free fatty acids and volatile sulfur compounds are known to impart fishy flavor to foods. Identification of the causative compounds to reduce and eventually eliminate fishy flavor is important for consumer acceptance of PUFA-fortified foods. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional text, tables, and figures.].
    Full-text · Article · Jan 2014
    • "In addition to these direct effects on the generation and duration of the action potential, other less direct mechanisms of actions have been proposed. There is also evidence for antiarrhythmic effects mediated through a reduced production of proarrhythmic eicosanoids, reduced levels of circulating catecholamines [38], and a reduced agonist affinity of beta-receptors [17]. The latter observation might be one of the mechanisms responsible for an improvement in the cardiac sympathetic-vagal balance, revealed clinically as a reduction in the mean heart rate (HR) [39] as well as an increase in HR variability [40]. "
    [Show abstract] [Hide abstract] ABSTRACT: This paper reviews the current evidence regarding long-chained marine omega-3 polyunsaturated fatty acids (PUFAs) and cardiovascular disease (CVD), their possible mechanisms of action, and results of clinical trials. Also, primary and secondary prevention trials as studies on antiarrhythmic effects and meta-analyses are summarized. However, the individual bioavailability of n-3 PUFAs along with the highly different study designs and estimations of FAs intake or supplementation dosages in patient populations with different background intake of n-3 PUFAs might be some of the reasons for the inconsistent findings of the studies evaluating the impact of n-3 PUFAs on CVD. The question of an optimum dose of n-3 PUFAs or whether there exists a dose-response relation for n-3 PUFA supplementation is widely discussed. Moreover, the difficulties in interpreting meta-analyses are clearly demonstrated by two recently published meta-analyses (Rizos et al. and Delgado Lista et al.), evaluating the efficacy of n-3 PUFAs on CVD, including 12 common studies, but drawing opposite conclusions. We definitely need more large-scale, randomized clinical trials of long duration, also reporting harmful effects of n-3 PUFAs.
    Full-text · Article · Dec 2012
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