Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Singh, R.B.
Right arrow Articles by Kartik, C.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Singh, R.B.
Right arrow Articles by Kartik, C.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


Can n-3 fatty acids provide myocardial protection by decreasing infarct size and inhibiting atherothrombosis?

R.B. Singh*,1, M.A. Niaz2 and C. Kartik3

1 Preventive Cardiology and Heart, Medical Hospital and Research Centre, Moradabad, India
2 Centre of Nutrition and Heart, Medical Hospital and Research Centre, Moradabad, India
3 Department of Medicine, Subharti Medical College, Meerut, India

* Correspondence: Dr R. B. Singh, MD, Honorary Professor, Preventive Cardiology, Medical Hospital and Research Centre, Civil Lines, Moradabad-10 (UP) 244001, India.

Abstract

Objective To present our published and unpublished data on the role of n-3 fatty acids and coenzyme Q10, a potent antioxidant and ATP-sparing agent, in decreasing myocardial infarct size and inhibiting the development of experimental atherosclerosis.

Design and settings Various randomized controlled intervention trials of n-3 fatty acid rich diet, fish oil, mustard oil and coenzyme Q10 in patients with acute myocardial infarction (AMI) and human experimental studies conducted in a primary and secondary care centre in India. Randomized experiments in animals on the role of the above substances on atherosclerosis.

Results In the Indian Experiment study, intake of n-3 fatty acids was significantly higher in the n-3 fatty acid rich diet intervention group (n=204) from a few days to 1 year after, compared with the control group (n=202). Lactate dehydrogenase level increased less in the intervention group than in the control group. Total cardiac events, including fatal and non-fatal myocardial infarctions as well as sudden cardiac deaths, were significantly lower in the intervention group than in the control group. Two other randomized, controlled trials in patients with AMI revealed that fish oil and mustard oil treatments were associated with a significant reduction in cardiac events compared with the respective control groups. n-3 Fatty acids, in addition, significantly decreased infarct size, incidence of heart enlargement and arrhythmias. The use of an electrocardiographic score in both fish oil and placebo groups revealed that a low score was associated with a small size of infarct, a moderate score with a medium size of infarct, and high score with a large size of infarct. Incidence of heart enlargement, arrhythmias and total cardiac events were significantly more common in patients with moderate and large infarcts compared with small ones. Treatment with fish oil plus coenzyme Q10 seemed to provide additional beneficial effects to those obtained with fish oil alone, by reducing the rise of cardiac enzymes during AMI as well as the level of pro-inflammatory markers of risk. Both n-3 fatty acids and coenzyme Q10 administration decreased the degree of experimental atherosclerosis in animals.

Conclusion Fish oil and coenzyme Q10 may independently decrease infarct size, stabilize atherosclerosic plaques and inhibit experimental atherosclerosis. More studies are necessary to confirm these results.

Key Words: Fish oil • coenzyme Q10 • oxidative stress • bioenergetic • electrocardiographic

References

  1. White HD. Future of reperfusion therapy for acute myocardial infarction. Lancet. 1999;354:695–697[CrossRef][Web of Science][Medline]
  2. Khatter RS, Basu SK, Senior R, Lahiri A. Prognostic value of predischarge exercise testing, ejection fraction and ventricular ectopic activity in acute myocardial infarction. Am J Cardiol. 1996;78:136–141[Web of Science][Medline]
  3. Senior R, Basu S, Kinsey C, Schaffer S, Lahiri A. Carvedilol prevents remodelling in patients with left ventricular dysfunction after acute myocardial infarction. Am Heart J. 1999;137:646–652[CrossRef][Web of Science][Medline]
  4. Kobayashi Y, Goto Y, Daikoku S, et al. Cardioprotective effects of intravenous nicorondil in patients with successful reperfusion for acute myocardial infarction. Jpn Circ J. 1998;62:183–189[CrossRef][Medline]
  5. Yusuf S, Slight P, Rossi P, et al. Reduction in infarct size, arrhythmias and chest pain by early intravenous beta blockade in suspected acute myocardial infarction. Circulation. 1983;67:132–141
  6. Feuerstein GZ, Hamberger SA, Smith EF, Bril A, Ruffolo RR. Myocardial protection with carvedilol. J Cardiovasc Pharmacol. 1992;19:38–41 (Suppl)
  7. Mancini GBJ. Role of angiotensin-converting enzyme inhibition in reversal of endothelial dysfunction in coronary artery disease. Am J Med. 1998;105(Suppl 1A):40–47
  8. Singh RB, Wander GS, Rastogi A, et al. Randomized, double blind, placebo controlled trial of Q10 in patients with acute myocardial infarction. Cardiovasc Drug Ther. 1998;12:347–353[CrossRef][Web of Science][Medline]
  9. GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999;354:447–455[CrossRef][Web of Science][Medline]
  10. Singh RB. GISSI Prevenzione Trial. (letter)Lancet. 1999;354:1556[Web of Science][Medline]
  11. De Lorgeril M, Salen M, Martin JL, Monlaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99:779–785[Abstract/Free Full Text]
  12. Singh RB, Niaz MA, Sharma JP, et al. Randomized double blind, placebo controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian Experiment of Infarct Survival-4. Cardiovasc Drug Ther. 1997;11:485–491[CrossRef][Web of Science][Medline]
  13. Landmark K, Abdelnoor M, Urdal P, et al. Use of fish oil appears to reduce infarct size as estimated from peak creatinine kinase and lactate dehydrogenase activities. Cardiology. 1998;89:94–102[CrossRef][Web of Science][Medline]
  14. Sellmayer A, Witzgall H, Lorenz RL, Weber PC. Effects of dietary fish oil on ventricular premature complexes. Am J Cardiol. 1995;76:974–977[CrossRef][Web of Science][Medline]
  15. von Shacky C, Angerer P, Kothny W, Theisen K, Mudra H. The effect of n-3 fatty acids on coronary atherosclerosis. A randomized, double blind, placebo controlled trial. Ann Int Med. 1999;130:554–562[Abstract/Free Full Text]
  16. Singh RB, Niaz MA, Agarwal P, Beegum R, Rastogi SS. Effect of antioxidant rich foods on plasma ascorbic acid, cardiac enzyme and lipid peroxide levels in patients hospitalized with acute myocardial infarction. J Am Diet Assoc. 1995;95:775–780[CrossRef][Web of Science][Medline]
  17. Singh RB, Rastogi SS, Verma R, Bolaki L, Singh R, Ghosh S. An Indian experiment with nutritional modulation in acute myocardial infarction. Am J Cardiol. 1992;69:879–885[CrossRef][Web of Science][Medline]
  18. Singh RB, Rastogi SS, Verma R, et al. Randomized, controlled trial of cardioprotective diet in patients with acute myocardial infarction: results of one year follow up. Br Med J. 1992;304:1015–1019
  19. Culp BR, Lands WEM, Luchesi BR, Patt B, Romson J. The effect of dietary supplementation of fish oil on experimental myocardial infarction. Prostaglandins. 1980;20:1020–1031
  20. Hock CE, Holaban ME, Reibel DK. Effect of dietary fish oil on myocardial phospholipids and myocardial ischaemic damage. Am J Physiol. 1987;252:H554–H560
  21. Matsukura T, Miyagawa M, Satoh K, Mineo S, Yanagisawa A, Ishikawa K. Effect of dietary fish oil on infarct size in feline myocardial ischaemia. Circulation. 1990;82(Suppl III):III–39
  22. Oskarsson HJ, Gowin J, Gunnar RM, Thomas JX Jr. Dietary fish supplementation reduces myocardial infarct size in canine model of ischaemia and reperfusion. J Am Coll Cardiol. 1993;21:1280–1285[Abstract]
  23. Zhu BQ, Sievers RE, Sun YP, Morsh-Fishure N, Parmley WW, Wolfe CL. Is the reduction of myocardial infarct size by dietary fish oil the result of altered platelet function? Am Heart J. 1994;127:744–755[CrossRef][Web of Science][Medline]
  24. Black KL, Culp B, Medison D, Randall OS, Lands WEM. The protective effects of dietary fish oil on focal infarction. Prostaglandins Med. 1979;3:257–268[CrossRef][Web of Science][Medline]
  25. Marangoni F, Angeli MT, Tarantino A, Bonabello A, Galli C. Transcutaneous absorption and incorporation of 3(11) EPA (20:5, n-3) in lipids of subcutaneous fluid, plasma and liver in the rat. Drevon CA, Baaksaas I, Krokan HE. Omega-3 Fatty Acids: Metabolism and Biological Effects. Switzerland: Birkhauser Verlag; 1993. p. 35–40
  26. Burr ML, Fehily AM, Gilbert IF, et al. Effects of changes in fat, fish and fibre intakes on death and myocardial reinfarction: Diet and reinfarction trial (DART). Lancet. 1989;ii:757–761
  27. Enas EA, Yusuf S. Third meeting of the international working group on coronary artery disease in south Asians. Indian Heart J. 1999;51:99–103[Medline]
  28. Grande P, Christiansen C, Alstrup K. Comparison of ASAT, CK, CK-MB, and LD for the estimation of acute myocardial infarction in man. Clin Chim Acta. 1983;128:329–335[CrossRef][Web of Science][Medline]
  29. Hindman N, Grande P, Harrell FE Jr, Anderson C, Harrison D, Ideker RE, Selvester RH, Wagner GS. Relation between electrocardiographic and enzymatic methods of estimating acute myocardial infarct size. Am J Cardiol. 1986;58:31–35[CrossRef][Web of Science][Medline]
  30. Alderich EA. Use of initial ST segment elevation as an indicator of final infarct size. Am J Cardiol. 1988;343:12–16[CrossRef]
  31. Dyerberg J, Bang HO, Stofferson E. Eicosapentaenoic acid and prevention of thrombosis and atherosclerosis. Lancet. 1978;ii:117–119
  32. Aursnes I, Derum HP, Smith P, et al. Low and high risk coronary patients discriminated by blood platelets fatty acid composition. Scand J Clin Lab Invest. 1986;46:115–120[Web of Science][Medline]
  33. Gudbjamason S. Dynamics of n-3 and n-6 fatty acids in phospholipids of heart muscle. J Int Med. 1989;225(Suppl 1):117–128[Web of Science][Medline]
  34. Schacky CV, Fischer S, Weber PC. Long term effects of dietary marine n-3 fatty acids upon plasma and cellular lipids, platelet function and eicosanoid formation in humans. J Clin Invest. 1985;76:1626–1631
  35. Mehra J, Lawson D, Saldeen T. Reduction in plasminogen activator inhibitor-1(PAI-1) with n-3 polyunsaturated fatty acids intake. Am Heart J. 1988;116:1201–1206[CrossRef][Web of Science][Medline]
  36. Shimokawa H, Vanhoutte PM. Dietary cod-liver oil improves endothelium dependent responses in hypercholesterolemic and atherosclerosic porcine coronary arteries. Circulation. 1988;78:1421–1430[Abstract/Free Full Text]
  37. Eritsland J, Arnesen H, Gronseth K, Fjeld NB, Abdelnoor M. Effect of dietary supplementation with n-3 fatty acids on coronary artery bypass graft patency. Am J Cardiol. 1996;77:31–36[CrossRef][Web of Science][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Singh, R.B.
Right arrow Articles by Kartik, C.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Singh, R.B.
Right arrow Articles by Kartik, C.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?