Do omega-3 supplements really benefit the heart?

Omega 3 fatty acids and its heart health beneficial effects are very popular. As per ADA CHD patients can take 1gm of EPA/DHA daily. Despite all benefits, positive heart outcomes of omega-3 fatty acids trials are still inconsistent and there is clinical controversy related to omega-3 fatty acids heart health protection. This demands a better understanding of the effect of omega-3 PUFA supplantation on CVD.

Heart beneficial mechanism of action of omega 3 fatty acids

• EPA maintains membrane stability and inhibits lipid oxidation & cholesterol domain formation
• DHA increases membrane fluidity, promotes cholesterol domains, reduces antioxidant activity

EPA+DHA

• Offers anti-inflammatory activity, alters prostaglandin synthesis, decreasing C-reactive protein and inflammatory cytokines synthesis
• Stabilizes membrane, antiarrhythmic actions and decreases cholesterol oxidation
• Decreases Cyclooxygenase-2 and Thromboxane A2 and improves endothelial action
• Decreases Triglyceride-rich lipoproteins, Apolipoprotein B and Apolipoprotein C3 levels
• Stabilizes plaque formation, decreases foam cells and plaque volume
• Lowers blood pressure and improves endothelial functions

Adverse effect

• Causes belching, nausea, and dysgeusia (fishy taste)
• Brings skin eruptions, eczema, and itching.
• Increases low-density lipoprotein cholesterol levels & atrial fibrillation incidence
• May cause bleeding via antiplatelet and membrane fluidity effects

Arterial Filtration (AF) risk

Omega-3 intake directly affects cardiac calcium, sodium & potassium ionic currents and ventricular action potential duration. Cumulatively this promotes re-entrant arrhythmias, despite being anti-arrhythmic in therapeutic conditions.

PIEZO1, inactivated by DHA and activated by EPA, its protein blades flatten, central pores open and causes calcium influx.

DHA/EPA ratio affects calcium-dependent signalling & AF likelihood. Atrial structural remodelling and pro-arrhythmic environment creation are promoted due to omega-3 fatty acid-linked PIEZO1 alteration. There is a change in voltage-gated ion channels, ionic pumps, cell surface receptors, and extracellular matrix-cytoskeletal interactions.

Detailed research is required to understand omega-3 fatty acid consumption & AF risk.  

Future Therapeutic Potential of Omega-3 Fatty Acid

• Develop a clinical trials strategy, combining therapeutic omega-3 oral supplements and injection regimens together
• Identify omega-3 fatty acid post-acute injury protection
• Find similarities and differences between chronic and acute omega-3 administration

Omega 3 fatty acid usage recommendations

Replace saturated fats with PUFA, and consume 2 servings of omega-3 fatty acids/week. Educate consumers to identify appropriate EPA/DHA formulations containing organic pollutants and mercury content.

Conclusion

Omega-3 fatty acids offer promising heart-benefiting effects but do not affect major adverse cardiac events, all-cause death, sudden cardiac death, revascularization, or high blood pressure.

Do not encourage Supplementation but promote eating a balanced diet enriched with omega-3 fatty acids.

In high-risk patient populations & clinical practice, Doctors should balance the benefits and harm of omega-3 FA for CVD prevention and treatment. Patient education should be done by pharmacists regarding the wide range of over-the-counter omega-3 FA supplementation products.

References

1. Int. J. Mol. Sci. 2022, 23, 2104
2. Annu. Rev. Nutr. 2020. 40:161–87
3. American Family Physician,2018;97(9) www.aafp.org/afp
4. S Afr Med J 2020;110(12):1158-1159
5. Rev. Cardiovasc. Med. 2023; 24(1): 24
6. Korean J Intern Med 2023;38:282-289
7. Rev. Cardiovasc. Med. 2023; 24(1): 24
8. JACC,2021;77(5):593-608
9. Canadian Family Physician,2023;69