More evidence – Fish Oil and Heart Failure
This article has taken excerpts from the American Heart Failure Society. It is very important to note that the EPA levels were high which indicates very refined fish oil – this is very important.
This article has been reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. Oh and sorry it is a bit technical but it needs to be.
“Patients with early-stage nonischemic cardiomyopathy derived significant functional and echocardiographic benefits from the addition of omega-3 fatty acids to optimized medical therapy, results of a randomized clinical trial showed. Omega-3 supplementation was associated with significantly greater improvement in left ventricular ejection fraction (LVEF, P=0.0001), exercise capacity (P<0.00), and hospitalization for heart failure (P=0.0002), as compared with medical management plus placebo. "Whether this intervention will have similar effects for patients with other etiologies, more advanced stages of heart failure, or for patients who are not on evidenced-based therapy remains unknown," Mihai Gheorghiade, MD, of Northwestern University in Chicago, said here at the Heart Failure Society of America meeting. "I am hoping that further studies will be conducted to assess the effects of this potentially important therapy on left ventricular function and clinical outcomes in other patients." The results build on previous evidence from an Italian intergroup study showing that omega-3 polyunsaturated fatty acid supplementation improved outcomes in patients with chronic heart failure, irrespective of etiology or LVEF (Lancet 2008; 372: 1090-1098). In an effort to clarify the spectrum of benefits, Gheorghiade and colleagues performed a multicenter, randomized clinical trial involving patients with nonischemic cardiomyopathy and minimal or no symptoms; 93 patients were included in the final analysis. Eligible patients had left ventricular systolic dysfunction associated with an LVEF ?45% on evidenced-based treatment for at least six months and stable clinical status for at least three months. Patients were randomized to 850 to 882 mg a day of eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) or matching placebo. Treatment continued for a year, and patients had monthly follow-up assessments. Assessments performed at baseline and at the end of the study included electrocardiography, echocardiography, renal function, and concentrations of inflammatory cytokines and fatty acids. The echocardiographic evaluation included left ventricular end-diastolic and end-systolic diameter and volume, LVEF, shortening fraction, and extent of mitral regurgitation. In the final analysis, measurement of EPA and DHA levels showed significant increases from baseline (P<0.001) and compared with levels of those in the placebo group (P<0.001), whose fatty acid concentrations did not change significantly from baseline to 12 months. Cytokine assessment showed that concentrations of tumor necrosis factor-alpha, interleukin-8, and interleukin-1 all increased significantly in the placebo group (P<0.001) and decreased significantly in patients who received omega-3 supplementation (P<0.001). Between-group comparisons showed significantly lower levels of all three cytokines in the omega-3 group (P<0.001 for all comparisons). LVEF decreased from about 37% at baseline to about 35% at 12 months in the placebo group (P<0.001) but increased from about 35% at baseline to more than 38% at 12 months in the group that received the supplements (P<0.001 versus baseline and versus placebo). Exercise tests showed significant improvement in the omega-3 group from baseline to 12 months compared with the placebo group, whether expressed as peak VO2 (P<0.001) or percent VO2 max (P=0.006). In the supplementation group, patterns of NYHA functional class showed a shift from class I to class II and no patients in class III at baseline or 12 months. In the placebo group, the proportion of patients in class I did not change, the proportion in class II declined, and a substantial proportion of patients progressed from class II to class III. The trial was not designed to assess the impact of supplementation on hospitalization rates. However, an exploratory analysis showed that the addition of omega-3 supplements to medical therapy was associated with significantly fewer heart failure hospitalizations (6% versus 30%, P=0.0002) and cardiovascular hospitalization (~15% versus 30%, P=0.0029) and a trend toward fewer hospitalizations for any reason (<30% versus >40%, P=0.0599).
Results of the study support the case for a “real” effect of omega-3 fatty acids in heart failure, Stephen Goldsmith, MD, of the University of Minnesota in Minneapolis, said during an invited discussion of the study.
“Given that some experts are already calling for the addition of omega-3 fatty acids to the guidelines for heart failure therapies, a second large randomized controlled trial would seem indicated, including both ischemic and nonischemic patients across a range of clinical severity,” said Goldsmith.
“It would be desirable in any such trial to include substudies dealing with left ventricular functional parameters, exercise capacity, and biomarkers, to confirm the current findings and potentially extend their applicability.”