CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 6, July 2012
AFRICA
345
Your Life and Your Heart
Focus on omega-3 PUFAs in heart failure
The therapeutic use of omega-3
polyunsaturated fatty acids (PUFAs) has
been acknowledged for the first time,
as being of value in reducing the risk
of hospitalisation for cardiovascular
disease and death, in the latest heart
failure guidelines released by the
European Society of Cardiology (ESC).
1
Importantly, the level of evidence for
this form of nutritional supplement
was evaluated as support for this new
ESC recommendation. The heart failure
guidelines also note the need for the
selection of quality formulations and a
dosage of at least 1 g daily.
Supporting evidence was mainly
from the GISSI-HF trial – a trial of
6 975 patients with NYHA class II–IV
symptoms and an ejection fraction
≤
40%,
which has shown that omega-3 PUFA
treatment led to a relative risk reduction
(RRR) of 8% in the co-primary composite
outcome of death or cardiovascular
hospitalisation in the adjusted analysis.
There was no reduction in heart failure
hospitalisation, but there was a 10% RRR
in cardiovascular mortality and 7% RRR
in overall cardiovascular hospitalisation.
2
The ranking of the use of omega-3
PUFAs above that of statins, which are not
recommended and are of unproven benefit
for heart failure patients, certainly raises
the profile of this nutritional supplement
in cardiological use. Cardiologists are
aware of the large GISSI-Prevensione
trial
3
of more than 11 000 post-myocardial
infarction patients treated with omega-3
PUFAs, which also showed a reduction in
cardiovascular death.
The
Cardiovascular Journal of Africa
published an evaluation of South African-
formulated omega-3 supplements by the
South African Medical Research Council
(MRC), indicating inadequate regulatory
structure to check claimed levels of EPA
and/or DHA in these products.
4
This is
an important factor to consider when
advising patients on which omega-3
formulations are subject to international
regulatory scrutiny. The need to reduce
side effects such as nausea and minor
gastrointestinal disturbances is also better
addressed by formulations that seek to
avoid any possible fish oil aftertaste.
Primary prevention with omega-
3 PUFAs
The use of omega-3 supplements early
as a health-maintenance strategy in
order to prevent the development of
cardiovascular disease is widely accepted,
although a recent trial in patients with
early type 2 diabetes was not able to
show cardiovascular benefits over a
six-year period, despite a drop in serum
triglyceride levels.
5
A larger Danish study
of 57 000 middle-aged men and women
who were healthy and cancer free was,
however, able to show a lower risk of
acute coronary syndromes in the men
with a high fatty fish intake over a mean
follow-up period of more than seven
years.
6
Julia Aalbers
References
1.
ESC guidelines for the diagnosis and treat-
ment of acute and chronic heart failure
2012.
Eur Heart J.
DOI:10.1093/eurheartj/
ehs 104.
2.
Tavazzi L, Maggioni AP, Marchioli R,
et
al
. Effect of n-3 PUFA in patients with
chronic heart failure (the GISSI-HF trial):
a randomised, double-blind placebo-
controlled trial.
Lancet
2008;
372
: 1223–
1230.
3.
Dietary supplementation with n-3 PUFA
and vitamin E, after MI results of the
GISSI-Prevenzione trial.
Lancet
1999;
354
:
447–455.
4.
Opperman M, Marais DW, Benade AJS.
Analysis of omega-3 fatty acid content
of South African fish oil supplements.
Cardiovasc J Afr
2011;
22
(6): 324–329.
5.
The ORIGIN trial investigators n-3 fatty
acids and cardiovascular outcomes in
patients with dyslycaemia.
N Eng J Med
2012. DOI:10:1056/NEJMoa/203858.
6.
Bjerregaard LJ, Joensen AM, Dethlefsen
C,
et al
. Fish intake and acute coronary
syndrome.
Euro Heart J
2010;
31
: 29–34.
Cardiovascular Journal of Africa
special reports and podcasts
ESC congress, Munich, 2012
The
Cardiovascular Journal of Africa
will be attending the 2012
ESC congress and reporting on the latest developments. A new
innovation is the introduction of podcasts, where we will interview
major presenters and publish these interesting interviews on our
website.
If you would like your symposium or poster presentation to be
covered, please contact Julia Aalbers at
.
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