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Fish Oil and Coronary Heart Disease
R. Marchioli, at the aboratorio di Epidemiologia Clinica delle Malattie Cardiovascolari, in Santa Maria Imbaro (CH), Italy has developed research for the relationship of omega-3 fatty acids(fish oils) and cardiovascular disease. In this study they reviewed case other case studies of the benefits and downfalls of fish oils. In the population studies which they researched indicated omega-3 that a high fish intake, such as reported in the Eskimo and Japanese studies, is associated with a low mortality from coronary heart disease (CHD). These effects have been associated with measurable effects on a series of established and possible risk factors. In the later population studies much lower daily intake of fish has been observed, such intake having only small or not even measurable effects on established risk factors. Still, their association with reduced CHD mortality, particularly sudden cardiac death seem to be well established.
Beneficial effects are found at a level of consumption of about 30 g per day or 1 fish meal per week compared with populations rarely to almost never consuming fish. Such findings are also shown in studies including analysis of fatty acid composition in adipose tissue and cell membranes. Fish consumption may be a marker for a healthier lifestyle or, alternatively, fish consumers may be at higher self-perceived risk for CHD and are therefore eating fish to reduce their high baseline risk factors. Despite all the limitations, the population studies seem to indicate that a high fish intake is associated with a low mortality from CHD. After these findings Marchioli set out to do his own research. GISSI-Prevenzione was conceived as a population, pragmatic trial on patients with recent myocardial infarction and it was conducted in the framework of the Italian public health system.
In GISSI-Prevenzione, 11,323 patients were enrolled in a clinical trial aimed at testing the effectiveness and benefits of omega-3 PUFA and vitamin E. Patients were asked to follow Mediterranean dietary habits, and were treated with up-to-date preventive pharmacological interventions. Long-term omega-3 PUFA 1 g daily, but not vitamin E 300 mg daily, was beneficial for death and for combined death, non-fatal myocardial infarction, and stroke. All the benefit, however, was attributable to the decrease in risk for overall, cardiovascular, cardiac, coronary, and sudden death.
In GISSI-Prevenzione, long-term administration of omega-3 PUFA (1 g daily) significantly decreased the risk of overall (-20%), cardiovascular (-30%), and sudden death (-45%). At variance from the orientation of a scientific scenario largely dominated by the "cholesterol-heart hypothesis", GISSI-Prevenzione results indicate omega-3 PUFA (virtually devoid of any cholesterol-lowering effect) as a relevant pharmacological treatment for secondary prevention after myocardial infarction. This and other research on this topic was published in October 2003 in Minerva Cardioangiol.
Fish Oil and the Reduction of Coronary Heart Disease
D, Mozzafarian (principal researcher) at the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts researched the interplay between different polyunsaturated fatty acids and risk of coronary heart disease in men. The background for this study was that consumption of polyunsaturated fatty acids (PUFAs, found in common fish and other marine animals) may reduce coronary heart disease (CHD) risk, but n-6 PUFAs may compete with n-3 PUFA metabolism and attenuate benefits.
Additionally, seafood-based, long-chain n-3 PUFAs may modify the effects of plant-based, intermediate-chain n-3 PUFAs. However, the interactions of these PUFAs in relation to CHD risk are not well established. 45,722 men participated in this 14 year study. The men in this study as of 1986 were free of known cardiovascular disease.
Their usual dietary intake was assessed at baseline and every 4 years by using validated food-frequency questionnaires. CHD incidence was prospectively ascertained. Over 14 years of follow-up, participants experienced 218 sudden deaths, 1521 nonfatal myocardial infarctions (MIs), and 2306 total CHD events (combined sudden death, other CHD deaths, and nonfatal MI).
In multivariate-adjusted analyses, both long-chain and intermediate-chain n-3 PUFA intakes were associated with lower CHD risk, without modification by n-6 PUFA intake. n-3 PUFAs from both seafood and plant sources may reduce CHD risk, with little apparent influence from background n-6 PUFA intake. Plant-based n-3 PUFAs may particularly reduce CHD risk when seafood-based n-3 PUFA intake is low, which has implications for populations with low consumption or availability of fatty fish.
The main point is that the seafood n-3’s, fish oils, help reduce the risk of CHD, but when that intake is low plant based n-3’s can help pick up the slack. This research was published in January 2005 and can be found under Circulation on MEDLINE.
Fish Oil and Increased Mortality from Coronary Artery Disease
Moderate fish-oil supplementation reverses low-platelet, long-chain n–3 polyunsaturated fatty acid status and reduces plasma triacylglycerol concentrations in British Indo-Asians was the title of the study done by researchers Julie A Lovegrove, Sean S Lovegrove, Stephanie VM Lesauvage, Louise M Brady, Nicky Saini, Anne M Minihane and Christine M Williams at the From the Hugh Sinclair Unit of Human Nutrition, School of Food Biosciences, The University of Reading, Reading, United Kingdom.
The background of this study was to evaluate the mechanisms involved in the increased mortality from coronary artery disease in British Indo-Asians are not well understood. This study aimed to investigate whether British Indo-Asian Sikhs have higher plasma triacylglycerol concentrations, lower platelet phospholipid levels, and lower dietary intakes of long-chain n–3 polyunsaturated fatty acids (PUFAs) than do age- and weight matched Europeans and whether moderate dietary fish oil intake can reverse these differences. The study was designed as follows: a randomized, double blind, placebo-controlled, parallel, fish oil intervention study was performed.
After a 2-week run-in period, 44 Europeans and 40 Indo-Asian Sikhs were randomly assigned to receive either 4.0 g of fish oil [1.5 g eicosapentaenoic acid (EPA) and 1.0 g docosahexaenoic acid (DHA)] or 4.0 g olive oil (control) daily for 12 week. The researchers found at baseline, the Indo-Asians had significantly higher plasma triacylglycerol, small dense LDL, apolipoprotein B, and dietary and platelet phospholipid n–6 PUFA values and significantly lower long-chain n–3 PUFAs (EPA and DHA) than did the Europeans.
A significant decrease in plasma triacylglycerol, plasma apolipoprotein B-48, and platelet phospholipid arachidonic acid concentrations and a significant increase in plasma HDL concentrations and platelet phospholipid EPA and DHA levels were observed after fish oil supplementation.
No significant effect of ethnicity on the responses to fish oil supplementation was observed. And the researchers concluded moderate fish oil supplementation contributes to a reversal of lipid abnormalities and low n–3 PUFA levels in Indo-Asians and should be considered as an important, yet simple, dietary manipulation to reduce CAD risk in Indo-Asians with an atherogenic lipoprotein phenotype.
Fish Oil and Progression of Coronary Artery Disease
Fish intake is associated with a reduced progression of coronary artery atherosclerosis in postmenopausal women with coronary artery disease was the name of the study conducted by head researchers Arja T Erkkilä, Alice H Lichtenstein, Dariush Mozaffarian and David M Herrington From the Cardiovascular Nutrition Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, in Boston. The research was published in JAMA in October of 2006.
The background of the study was higher intakes of fish and n–3 fatty acids are associated with a reduced risk of cardiovascular events and mortality. However, limited data exist on the effect of fish intake on actual measures of progression of coronary artery atherosclerosis. The aim was to examine the association between fish intake and the progression of coronary artery atherosclerosis in women with coronary artery disease.
This was a prospective cohort study of 229 postmenopausal women participating in the Estrogen Replacement and Atherosclerosis trial. Usual fish intake was estimated at baseline with a food-frequency questionnaire. Quantitative coronary angiography was performed at baseline and after to evaluate changes in the mean minimum coronary artery diameter, the mean percentage of stenosis, and the development of new coronary lesions.
The results were compared with lower fish intakes, consumption of 2 servings of fish or 1 serving of tuna or dark fish per week was associated with smaller increases in the percentage of stenosis in diabetic women after adjustments for age, cardiovascular disease risk factors, and dietary intakes of fatty acids, cholesterol, fiber, and alcohol. These associations were not significant in nondiabetic women.
Higher fish consumption was also associated with smaller decreases in minimum coronary artery diameter and fewer new lesions. The final conclusion was consumption of fish is associated with a significantly reduced progression of coronary artery atherosclerosils in women with coronary artery disease. Fish oils, but not atorvastatin, influence HDL metabolism chiefly by decreasing both the catabolism and production of HDL apo A-I and HDL apo A-II in insulin-resistant obese men. Addition of atorvastatin to treatment with fish oils had no additional effect on HDL kinetics compared with fish oils alone.
Fish Oil and Serum Lipoprotein in Coronary Heart Disease
A research study entitled “Dietary Oils, serum lipoprotein, and coronary heart disease,” was published in The Journal of Nutrition in the October 2006 edition. The principal researchers were MB Katan, PL Zock and RP Mensink. The research was performed at The Department of Human Nutrition, Wageningen Agricultural University, Netherlands.
Variable amounts of olive oil rather than hard fats were used in classic Mediterranean diets. We review the effects of replacing hard fats with olive oils or starchy foods on blood lipoprotein concentrations. The saturated fatty acids lauric, myristic, and palmitic acids raise both low-density lipoprotein (LDL) and high- density lipoprotein (HDL) somewhat compared with oleic acid.
If carbohydrates replace any fat, fasting triglyceride values rise and HDL concentrations fall; effects on LDL depend on the type of fat that is being replaced. Trans isomers of oleic acid lower HDL and raise LDL and lipoprotein (a). The fatty acids in unhydrogenated fish oil potently lower triglycerides but may raise LDL somewhat.
When body weight is forcibly kept constant, substitution of unsaturated oils such as olive oil for hard fats rich in saturated or trans fatty acids will produce a more favorable lipoprotein profile than replacement of fat by carbohydrates. However, high-oil diets might lead to obesity, which would undo their favorable effects.
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