Congestive heart failure and omega-3-fatty acids

Congestive Heart Failure Microchapters

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Chronic Pharmacotherapy in HFrEF

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Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
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Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
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Congestive heart failure end-of-life considerations

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Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kalsang Dolma, M.B.B.S.[2]

## Omega-3 Fatty Acid

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### Therapeutic Role of Omega-3 Fatty Acid in Congestive Heart Failure

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#### Landmark Studies

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##### The GISSI-HF Trial (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico)

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* A double blind, placebo controlled trial by GISSI-HF investigator randomly assigned 6975 patients with chronic heart failure of New York Heart Association (NYHA) class II-IV to n-3 PUFA 1 g daily(n=3494) or placebo(n=3481) and were followed up for a median of 3.9 years. The study showed reduced death from any cause in n-3 PUFA group (27%) as compared to placebo group (29%). Also, the end points of deaths and admission to hospitals for cardiovascular reasons is lower in n-3 PUFA group (57%) in comparison to placebo group (59%).[1]
* A substudy of GISSI-HF trial done in 608 chronic heart failure patients indicates an increase in LV ejection fraction in n-3 PUFA group by 8.1% at 1st year, 11.1% at 2 years and 11.5% at 3 years as compare to placebo group with increase of 6.3% at 1 year, 8.2% at 2 years and 9.9% at 3 years. This small but statistically significant advantage in terms of LV function by n-3 PUFA supplementation has been seen in patients with symptomatic heart failure of any etiology.[2]

### Preventive Role of Omega-3 Fatty Acid in Congestive Heart Failure

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Limited data suggests the preventive role of n-3 PUFA supplementation in lowering the incidence of heart failure. Controlled studies with omega-3 fish oil suggest its cordioprotective role in heart failure. The American Heart Association has recently recommended the use of fish and/or fish oil supplements for all patients with cardiovascular diseases.

#### Landmark Studies

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* A prospective cohort study in 4738 adults of >65 years without heart failure at baseline, has shown that consumption of tuna and other broiled or baked fish is associated with lower incidence of heart failure and no such association is found in individuals consuming fried fish.[3]
* Another prospective cohort study in 2735 US adults without prevalent heart disease has shown that plasma phospholipid eicosapentanoic acid (EPA) concentration is inversely related with incident CHF. This result also supports that participants with higher levels of omega-3 fatty acid are less likely to develop congestive heart failure in follow up.[4][5]

## References

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1. ↑ Tavazzi L, Maggioni AP, Marchioli R; et al. (2008). "Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial". Lancet. 372 (9645): 1223–30. doi:10.1016/S0140-6736(08)61239-8. PMID 18757090. Unknown parameter `|month=` ignored (help)CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
2. ↑ Ghio S, Scelsi L, Latini R; et al. (2010). "Effects of n-3 polyunsaturated fatty acids and of rosuvastatin on left ventricular function in chronic heart failure: a substudy of GISSI-HF trial". Eur. J. Heart Fail. 12 (12): 1345–53. doi:10.1093/eurjhf/hfq172. PMID 20952767. Unknown parameter `|month=` ignored (help)CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
3. ↑ Mozaffarian D, Bryson CL, Lemaitre RN, Burke GL, Siscovick DS (2005). "Fish intake and risk of incident heart failure". J. Am. Coll. Cardiol. 45 (12): 2015–21. doi:10.1016/j.jacc.2005.03.038. PMID 15963403. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
4. ↑ Mozaffarian D, Lemaitre RN, King IB; et al. (2011). "Circulating long-chain ω-3 fatty acids and incidence of congestive heart failure in older adults: the cardiovascular health study: a cohort study". Ann. Intern. Med. 155 (3): 160–70. doi:10.1059/0003-4819-155-3-201108020-00006. PMC 3371768. PMID 21810709. Unknown parameter `|month=` ignored (help)CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
5. ↑ Wilk JB, Tsai MY, Hanson NQ, Gaziano JM, Djoussé L (2012). "Plasma and dietary omega-3 fatty acids, fish intake, and heart failure risk in the Physicians' Health Study". The American Journal of Clinical Nutrition. 96 (4): 882–8. doi:10.3945/ajcn.112.042671. PMID 22952185. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)

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