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STATE-OF-THE-ART PAPER

Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Diseases

Carl J. Lavie, MD^_*,_*, Richard V. Milani, MD^_*, Mandeep R. Mehra, MD and Hector O. Ventura, MD^_*

^_* Department of Cardiovascular Diseases, Ochsner Medical Center, New Orleans, Louisiana
Division of Cardiovascular Diseases, University of Maryland School of Medicine, Baltimore, Maryland

Manuscript received February 5, 2009; accepted February 25, 2009.

^_* Reprint requests and correspondence: Dr. Carl J. Lavie, Cardiac Rehabilitation, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, Louisiana 70121-2483 (Email: clavie{at}ochsner.org).

Omega-3 polyunsaturated fatty acid (-3 PUFA) therapy continues to show great promise in primary and, particularly in secondary prevention of cardiovascular (CV) diseases. The most compelling evidence for CV benefits of -3 PUFA comes from 4 controlled trials of nearly 40,000 participants randomized to receive eicosapentaenoic acid (EPA) with or without docosahexaenoic acid (DHA) in studies of patients in primary prevention, after myocardial infarction, and most recently, with heart failure (HF). We discuss the evidence from retrospective epidemiologic studies and from large randomized controlled trials showing the benefits of -3 PUFA, specifically EPA and DHA, in primary and secondary CV prevention and provide insight into potential mechanisms of these observed benefits. The target EPA + DHA consumption should be at least 500 mg/day for individuals without underlying overt CV disease and at least 800 to 1,000 mg/day for individuals with known coronary heart disease and HF. Further studies are needed to determine optimal dosing and the relative ratio of DHA and EPA -3 PUFA that provides maximal cardioprotection in those at risk of CV disease as well in the treatment of atherosclerotic, arrhythmic, and primary myocardial disorders.

Key Words: cardiovascular diseases • fish oils • -3 polyunsaturated fatty acids

Abbreviations and Acronyms   -3 PUFA = omega-3 polyunsaturated fatty acids   AF = atrial fibrillation   AHA = American Heart Association   ALA = alpha-linolenic acid   CAC = coronary artery calcification   CHD = coronary heart disease   CV = cardiovascular   DHA = docosahexaenoic acid   EPA = eicosapentaenoic acid   FDA = Food and Drug Administration   HF = heart failure   ICD = implantable cardioverter-defibrillator   IMT = intima-media thickness   LDL = low-density lipoprotein   LV = left ventricular   MI = myocardial infarction   PPAR = peroxisome proliferator-activator receptor   SCD = sudden cardiac death

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