Fish oils and Atrial Fibrillation
It is important you read this report in context that the information only pertains to preventing AF in patients who have had an AF diagnosis with fish oils. There are lots of other benefits to individuals who take omega-3 fish oils.
The study, published in the Journal of the American College of Cardiology.
“The results for atrial fibrillation are important negative findings, answering key clinical and research questions,” said Dr. Dariush Mozaffarian, an omega-3 expert at the Harvard School of Public Health, who was not involved in the study.
The new research, combined with other trials, “indicates that short-term fish oil use is unlikely to prevent recurrent atrial fibrillation,” he said.
Atrial fibrillation, in which the heart’s upper chambers beat out of step with those below. The condition is linked to strokes and heart failure.
Although doctors prescribe certain medications to treat the condition, none to date has proven particularly effective. As a result, most drug treatment focuses on preventing strokes by administering blood thinners to dissolve clots caused by the fibrillation.
Some evidence suggests that omega-3 fatty acids, found in oily fish like sardines and tuna, might reduce the risk of atrial fibrillation, although exactly how they would produce their effect is not clear.
A study published earlier this year in Circulation, for example, found that people with the most omega-3s in their blood had a 30% lower chance of developing an irregular heart beat than those with the lowest concentrations of the substances.
That 30% difference would work out to eight fewer cases of atrial fibrillation per 100 people – which would be a meaningful benefit if it could be enjoyed by those with fibrillation or at risk for it, just by consuming more omega 3s.
But the latest study suggests that it probably can’t. The trial included 586 men and women with a history of atrial fibrillation who were given a gram a day of fish oil or dummy capsules for a year. Participants also were allowed to take other drugs to control their heart rhythms, as prescribed by their doctors.
At the end of the study period, about 24% of the people who took fish oil, and 20% of those who did not, had experienced a recurrence of atrial fibrillation – a difference so small, statistically, it was likely due to chance.
The findings on atrial fibrillation echo results from a study led by Mozaffarian published in November, of patients recovering from heart surgery.
Even so, Dr. Alejandro Macchia, a cardiologist at the GESICA Foundation in Buenos Aires, who led the current study and collaborated with Mozaffarian on the previous one, said fish oil may still prove beneficial for heart health, at least in some patients.
More evidence – Fish Oil and Heart Failure
This article has taken excerpts from the American Heart Failure Society. It is very important to note that the EPA levels were high which indicates very refined fish oil – this is very important.
This article has been reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. Oh and sorry it is a bit technical but it needs to be.
“Patients with early-stage nonischemic cardiomyopathy derived significant functional and echocardiographic benefits from the addition of omega-3 fatty acids to optimized medical therapy, results of a randomized clinical trial showed. Omega-3 supplementation was associated with significantly greater improvement in left ventricular ejection fraction (LVEF, P=0.0001), exercise capacity (P<0.00), and hospitalization for heart failure (P=0.0002), as compared with medical management plus placebo.
"Whether this intervention will have similar effects for patients with other etiologies, more advanced stages of heart failure, or for patients who are not on evidenced-based therapy remains unknown," Mihai Gheorghiade, MD, of Northwestern University in Chicago, said here at the Heart Failure Society of America meeting.
"I am hoping that further studies will be conducted to assess the effects of this potentially important therapy on left ventricular function and clinical outcomes in other patients."
The results build on previous evidence from an Italian intergroup study showing that omega-3 polyunsaturated fatty acid supplementation improved outcomes in patients with chronic heart failure, irrespective of etiology or LVEF (Lancet 2008; 372: 1090-1098).
In an effort to clarify the spectrum of benefits, Gheorghiade and colleagues performed a multicenter, randomized clinical trial involving patients with nonischemic cardiomyopathy and minimal or no symptoms; 93 patients were included in the final analysis.
Eligible patients had left ventricular systolic dysfunction associated with an LVEF ?45% on evidenced-based treatment for at least six months and stable clinical status for at least three months.
Patients were randomized to 850 to 882 mg a day of eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) or matching placebo. Treatment continued for a year, and patients had monthly follow-up assessments.
Assessments performed at baseline and at the end of the study included electrocardiography, echocardiography, renal function, and concentrations of inflammatory cytokines and fatty acids. The echocardiographic evaluation included left ventricular end-diastolic and end-systolic diameter and volume, LVEF, shortening fraction, and extent of mitral regurgitation.
In the final analysis, measurement of EPA and DHA levels showed significant increases from baseline (P<0.001) and compared with levels of those in the placebo group (P<0.001), whose fatty acid concentrations did not change significantly from baseline to 12 months.
Cytokine assessment showed that concentrations of tumor necrosis factor-alpha, interleukin-8, and interleukin-1 all increased significantly in the placebo group (P<0.001) and decreased significantly in patients who received omega-3 supplementation (P<0.001).
Between-group comparisons showed significantly lower levels of all three cytokines in the omega-3 group (P<0.001 for all comparisons).
LVEF decreased from about 37% at baseline to about 35% at 12 months in the placebo group (P<0.001) but increased from about 35% at baseline to more than 38% at 12 months in the group that received the supplements (P<0.001 versus baseline and versus placebo).
Exercise tests showed significant improvement in the omega-3 group from baseline to 12 months compared with the placebo group, whether expressed as peak VO2 (P<0.001) or percent VO2 max (P=0.006).
In the supplementation group, patterns of NYHA functional class showed a shift from class I to class II and no patients in class III at baseline or 12 months. In the placebo group, the proportion of patients in class I did not change, the proportion in class II declined, and a substantial proportion of patients progressed from class II to class III.
The trial was not designed to assess the impact of supplementation on hospitalization rates. However, an exploratory analysis showed that the addition of omega-3 supplements to medical therapy was associated with significantly fewer heart failure hospitalizations (6% versus 30%, P=0.0002) and cardiovascular hospitalization (~15% versus 30%, P=0.0029) and a trend toward fewer hospitalizations for any reason (<30% versus >40%, P=0.0599).
Results of the study support the case for a “real” effect of omega-3 fatty acids in heart failure, Stephen Goldsmith, MD, of the University of Minnesota in Minneapolis, said during an invited discussion of the study.
“Given that some experts are already calling for the addition of omega-3 fatty acids to the guidelines for heart failure therapies, a second large randomized controlled trial would seem indicated, including both ischemic and nonischemic patients across a range of clinical severity,” said Goldsmith.
“It would be desirable in any such trial to include substudies dealing with left ventricular functional parameters, exercise capacity, and biomarkers, to confirm the current findings and potentially extend their applicability.”
Great News about Fish Oils
Not to say I haven’t been saying so for a while but this is great news about the effect of fish oils – however please note that the fish oil is highly refined but the article which is in the Telegraph Newspaper does tell you where you can get some. Be aware when you but fish oils. I get my fish oils from here -
Be aware of cheap fish oil, they don’t contain the levels of DHA and EPA and always discuss any supplements with your Doctor or Heart Failure Nurse.
“A study found that people with heart failure, where the organ fails to beat with sufficient force, were less likely to die if they took fish oils.
Around 700,000 people in Britain suffer from the condition that has debilitating symptoms, including breathlessness and fatigue, that can be so severe patients may remain virtually housebound.
Prof Martin Cowie, of Imperial College London and the Royal Brompton Hospital in London, reviewed the study of almost 7,000 people with chronic heart failure and randomly assigned them to take 1 gram of fish oil capsules per day on top of their usual medication or a dummy pill.
There was a nine per cent reduction in deaths among those taking the fish oil after two years. There was also a cut in hospital admissions for the condition.
The results are now expected to be incorporated in Europe-wide guidelines for the treatment of heart failure.
Prof Cowie said if two thirds of heart failure patients took the capsules daily, it would mean around 10,000 lives a year would be saved.
Patients who have had a heart attack are already recommended to take 1g of fish oil per day and adding in all heart failure patients will mean the majority of people living with heart conditions will be taking the supplements.
The review, published in the European Journal of Cardiovascular Medicine, said cost-effectiveness studies were under way and are likely to show that prescribing fish oil in these patients would pass evaluation by the National Institute for Health and Clinical Excellence.
The fish oil used in the study was a high quality supplement containing 90 per cent omega-3 polyunsaturated fatty acid ethyl esters, called Omacor, rather than a standard over-the-counter product.
Omacor costs the NHS 51p per patient per day and it can also be obtained from a pharmacist without prescription.
The research paper said: “Although not yet licensed for use in patients with chronic heart failure, it is likely that updates on international guidelines will make a recommendation to at least consider increasing omega-3 PUFA ethyl esters consumption in the form of oily fish or capsules, 1g per day, in patients with chronic heart failure already optimally medically treated.”
It is thought the fish oils helps regulate heart rate and have an anti-inflammatory action which may help to relax blood vessels to ease the workload on the heart.
Dr Jeremy Pearson, deputy medical director at the British Heart Foundation, said: “Researchers have been trying to find something that fish oils really do so this is interesting. If people feel they can tolerate it, which most people do if they take capsules and not liquid, I don’t think there is any suggestion that they might be doing themselves any harm.”
Fish Oils “slows biological ageing”
Fish oil may be able to slow down biological ageing by extending the genetic “fuse” that controls how long cells survive, according to a study of heart disease patients.
The omega-3 fatty acids found in fish oil have been claimed to reduce heart disease, improve survival after a heart attack, slow mental decline and protect the eye from age-related changes that can cause blindness.
Although the mechanisms behind omega-3′s anti-inflammatory properties are not well understood, scientists said the fatty acids appear to slow down the shortening rate of protective caps at the end of chromosomes.
British Heart Foundation senior cardiac nurse, June Davison, said: “This is an interesting study which may offer a further explanation as to why a dietary intake of omega-3 fats from fish can help to protect your heart.
“It is well established that a dietary intake of omega-3 is good for heart health. Oily fish, such as salmon, mackerel or sardines, is a nutritious source of omega-3.
“Current UK guidelines state that the general population should have two portions of fish a week, one of which should be oily. Those who have had a heart attack should have two to three portions of oily fish a week.”
Complimentary Supplements and Heart Health
I would never suggest you don’t use your prescribed drugs from your Doctors and Nurses but I am getting very interested in all these complimentary supplements.
Before I had Heart Failure which was caused by a viral attack I was a great exponent of the following supplements –
High Potency Vitamin C
High Potency Vitamin D
Very good quality Fish Oil – High EPA and DHA levels – more expensive than the average but better for you
Plant Stereol supplement
These were taken every morning without fail. Now you may say well you got heart failure so they can’t be that good – well you are wrong. The results of my MRI cardiac scan indicated no signs of heart disease, furred arteries or scaring of the heart. I was just unlucky that a virus, it has been suggested herpes simplex (cold sore) or an influenza style virus attacked my heart.
So as well as my beta blockers, ACE inhibitor, spironolactone, diuretic, digoxin and warfarin I have now started back on the complimentary supplement route.
I now take –
Vitamin C 2000mg per day (1000mg in the morning and 1000mg at approx 6pm)
Vitamin D high potency (1 capsule in the morning)
Fish oil capsule once in the morning (EPA/DHA level is 950mg out of total 1360mg)
I have just bought some 6 hour bovine colostrum which from what I can gather may promote increased density of stem cell production and more, this is a very interesting product. I am just awaiting delivery from the USA.
I am looking to get myself associated with Q10 again, however Q10 is a pro-agulant and this will effect my INR warfarin level. I have researched Q10 for a while now and I came across a site that the kills two birds with one stone. Very good quality fish oil with added Ubiquibnol from Kaneka in Japan. Highly absorbent Q10 with highly refined fish oil as well.
In fact the whole site is excellent and seems to be a quality business. I will buy some and post the results.
What is a healthy diet?
A healthy diet can help to reduce your risk of getting coronary heart disease and therefore heart failure. If you already have heart problems, eating a good diet can help protect your heart from getting worse, as well as protecting you from other diseases such as diabetes and some cancers.
A healthy diet contains lots of fruit and vegetables, aim for at least five portions a day, either fresh, frozen, dried or tinned and starchy foods such as wholegrain bread, pasta and rice. It should also be low in fat, salt and sugar. Eating fish twice a week, including one portion of oily fish, such as salmon or mackerel) can also help to reduce your risk of heart disease.
I have no proof that supplements work however I am obsessed with the following but always check with your Doctor or Heart Failure Nurse first –
Fish oil supplements – make sure the EPA level is as high as possible High EPA Fish Oil
High Potency Vitamin C – read this opinion
High Potency Vitamin D – read this opinion
Acai Berry for it’s antioxidant properties – Acai Berry
As with all supplements and drugs it is very important that you discuss them with your clinician.