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Related Experiment Videos

n-3 fatty acids and revascularization procedures.

H Arnesen1

  • 1Ullevål University Hospital, Oslo, Norway. harald.arnesen@ulleval.no

Lipids
|February 12, 2002
PubMed
Summary

Very long chain n-3 polyunsaturated fatty acids (PUFA) show benefits in preventing vein graft occlusion after coronary artery bypass grafting (CABG) and in heart transplant patients. However, they are not recommended for preventing restenosis after percutaneous transluminal coronary angioplasty (PTCA).

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Area of Science:

  • Cardiovascular Medicine
  • Nutritional Science
  • Biochemistry

Background:

  • Long-chain n-3 polyunsaturated fatty acids (PUFA) have been investigated for cardiovascular benefits since the 1970s.
  • Laboratory and human studies suggest positive effects on eicosanoid metabolism, platelet activity, triglycerides, and cardiac arrhythmias.
  • A rationale exists for their use in secondary prevention after revascularization procedures.

Purpose of the Study:

  • To summarize the clinical effects of very long chain n-3 PUFA supplementation in secondary cardiovascular disease prophylaxis.
  • To evaluate the efficacy of n-3 PUFA in patients after coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), and heart transplantation.

Main Methods:

  • Review of prospective randomized trials and meta-analyses evaluating very long chain n-3 PUFA supplementation.

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  • Analysis of studies focusing on outcomes such as graft occlusion, restenosis, hypertension, and vasoreactivity.
  • Dose-response relationship and subgroup analyses were considered.

    • Main Results:

    • The SHOT study demonstrated a significant reduction in vein graft occlusion after CABG with 3.4 g/d n-3 PUFA.
    • Meta-analyses in 1993 suggested a positive effect on restenosis after PTCA, but later large trials (late 1990s) with higher doses (5.1-8.0 g/d) showed negative results.
    • Positive effects on surrogate endpoints like hypertension and coronary vasoreactivity were observed in heart transplant patients with 3.4-5.7 g/d n-3 PUFA.

    Conclusions:

    • Very long chain n-3 PUFA supplementation (up to 3.4 g/d) is recommended for patients after venous CABG.
    • Supplementation (3.4-5.7 g/d) may benefit heart transplant recipients regarding hypertension and vasoreactivity.
    • Current evidence does not support n-3 PUFA use for preventing restenosis after traditional PTCA; high doses may even be contraindicated due to potential proinflammatory effects.