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Omega-3 fatty acids are a type of unsaturated fatty acid. α -linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid are members of this family (DHA). EPA and DHA are required for the synthesis of nerve tissue, hormones, and cellular membranes. Although the body can synthesize EPA and DHA from ALA, this process is inefficient in most people. EPA is converted in the body to anti-inflammatory prostaglandins, which have been shown to lower blood pressure, cholesterol, and triglycerides; prevent the formation of atherosclerotic plaque; and improve some dermatologic conditions.

Omega-3 fatty acids are abundant in fatty fish such as salmon, mackerel, and tuna, krill as well as plant sources such as flaxseed and flaxseed oil, canola oil, soybean oil, and nuts. There are numerous over-the-counter omega-3 products on the market, as well as one prescription agent.

Benefits and Sources

It is well known that populations that consume a high amount of omega-3 fatty acids, such as the Eskimo population, have a lower incidence of heart disease. Regular intake of omega-3 fatty acids has been linked to a lower risk of death from cardiac events and nonfatal myocardial infarctions. Fish and krill oil consumption has been linked to lower blood pressure and coagulability (the body’s ability to clot), as well as lowering arrhythmias (abnormal heart rhythms) and improving endothelial function.

As previously stated, intake can take the form of a diet high in omega-3 fatty acids or supplements. According to research, there is no difference in the benefits conferred by an enriched diet or supplement. Both methods have been linked to a reduction in the risk of fatal infarction, sudden death, and total mortality.

Unless there are contraindications, the American Dietetic Association (ADA) recommends that a cardioprotective diet include omega-3 fatty acids, preferably from both marine and plant sources. To achieve cardioprotective effects, at least two servings of fish per week are recommended. Fatty fish, such as mackerel, salmon, herring, trout, sardines, or tuna, are recommended by the ADA to provide the most benefit. Marine-derived omega-3 fatty acids at doses of at least 3 g/d have been shown to lower triglycerides by approximately 30% in patients with significantly elevated triglyceride levels of more than 500 mg/dL.

Plant-based foods containing 1.5 g of ALA are also recommended, which can be found in 1 tablespoon of canola or walnut oil, 12 tablespoon of ground flaxseed, or less than 1 teaspoon of flaxseed oil. Some fatty fish may contain high levels of methylmercury; therefore, consumption should be limited.

Recommendations

The Adult Treatment Panel III of the National Cholesterol Education Project recommends omega-3 fatty acids as an adjunct to pharmacological therapy for lowering triglycerides. The American Heart Association has added to the evidence, recommending 2 to 4 g of EPA + DHA daily for patients with high triglycerides under the supervision of a medical professional. Fish oil lowers triglycerides at high doses, greater than 6 g/d, by inhibiting the synthesis of very low-density lipoprotein triglycerides and apolipoprotein B. DHA, in doses of 4g, has been shown to increase the size of low-density lipoprotein particles.

The most practical way to get this amount of omega-3 fatty acids is to take fish and krill oil supplements. Despite being labeled as 1000-mg capsules, most commercially available fish and krill oil supplements contain between 300 and 500 mg of EPA + DHA per capsule. There is a scarcity of well-tested supplements that have demonstrated the magnitude of lipid lowering seen with traditional pharmaceutical therapies. Nutritionists and pharmacists are well-positioned to provide information about supplements, such as the amount of EPA and DHA in each product and the dose required to achieve therapeutic benefit. Some sources recommend that fish and krill oil supplements be used pharmacologically only in patients with refractory hypertriglyceridemia and that apolipoprotein-B levels be monitored on a regular basis.

The evidence for the use of fish and krill oil in lowering blood pressure is compelling. A meta-analysis of 36 studies on fish and krill oil discovered that high doses of 3.7 g/d may have the potential to lower blood pressure by up to 6/4 mm Hg.

Safety

According to research, omega-3 fatty acids are safe and may benefit patients with lipid disorders such as elevated triglycerides. They almost never cause drug-drug interactions and have few bothersome side effects. However, the long-term safety of fish oil in doses sufficient to lower blood pressure is unknown. Potential side effects include:

  • a longer bleeding time, which increases the likelihood of bleeding
  • a decrease in the production of a renal vasodilator, which may lead to a decline in renal function
  • the sensation of a fishy taste
  • a possible deleterious effect on lipid metabolism

These factors, combined with the generally minor antihypertensive effect, argue against the routine use of fish oil supplements for this purpose. The patient’s adequate and complete education regarding the risk versus benefit of vitamins and supplements is a critical component in the treatment of hyperlipidemia.

 

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