Recommending Omega-3 Oils for Patients With Heart Risks
Question: How might a primary care clinician determine the appropriate role of omega fatty acids in patients at risk for cardiovascular disease?
Answer: The most protective omega-3 fatty acids (omega-3s) for cardiovascular health are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Sources of EPA and DHA include seafood/fish (especially cold-water fish), supplements, and prescription forms (Omacor, Reliant).
A survey of family physicians in Washington State found that only 17% of respondents recommended fish intake to their patients. Giving the recommendation was associated with having more time available for in-office dietary counseling.1
The primary and secondary preventive benefits of omega-3s in cardiovascular disease (CVD) were reviewed recently and include a 17% reduction in overall mortality and a 36% reduction in coronary death with 200–250 mg daily intake of EPA/DHA.2,3
Patients with known coronary heart disease may benefit from higher daily doses. The GISSI-Prevenzione trial involving more than 11,000 participants with recent myocardial infarction (MI) demonstrated that 1,000 mg/day of combined EPA/DHA reduced risk by 25%, 30%, and 45% for all-cause death, coronary death, and sudden death respectively, establishing the role for omega-3 oils in secondary prevention.4 Higher doses also appear to reduce heart rate and blood pressure and have antithrombotic effects. Additional cardiovascular benefits may include protection against ischemic stroke, nonfatal MI, progression of atherosclerosis, recurrent ventricular tachyarrhythmias, atrial fibrillation, and congestive heart failure.2,3,5,6
One exception to the overall cardiovascular benefits of omega-3 oils may be in patients with implantable defibrillators, in whom strong protective benefits have not been observed.7–9
Isolated case reports have raised concerns about the combination of omega-3 oils with anticoagulants, including aspirin and warfarin (Coumadin, Bristol-Myers Squibb). Although clinical trials testing the impact of omega-3–anticoagulant combinations are limited, significant impact on coagulation parameters has not been reported.10
Primary care providers should consider recommending the use of omega-3 oils (seafood/fish intake, supplementation, or prescription) to all patients with and at risk for CVD, with few exceptions. The recommended dose should depend on the patient's individual clinical goal and health status, but a recent American Heart Association statement provides more guidelines: consume fish, especially oily fish, at least twice weekly. Patients with CVD are advised to consume ∼1 g EPA and DHA per day, preferably from oily fish, but EPA and DHA supplements could be considered in consultation with their physician. In patients with hypertriglycemia, 2–4 g EPA and DHA daily in capsules may be recommended.11 ▪
Footnotes
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Ryan Bradley, ND, is a clinical faculty member for the Diabetes & Cardiovascular Wellness Program at Bastyr Center for Natural Health in Seattle.
- American Diabetes Association, Inc.
