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 Siscovick, D.S.
Right arrow Articles by Cobb, L.A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Siscovick, D.S.
Right arrow Articles by Cobb, L.A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


Long-chain n-3 polyunsaturated fatty acids and out-of-hospital primary cardiac arrest: clinical and public health implications of observational studies and clinical trials

D.S. Siscovick*,1,2, T.E. Raghunathan3, R. Lemaitre1, I. King4 and L.A. Cobb1

1 Cardiovascular Health Research Unit, Departments of Medicine, USA
2 Epidemiology, University of Washington, Seattle, USA
3 Institute for Social Research, University of Michigan, Ann Arbor, USA
4 Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA

* Correspondence: Dr David S. Siscovick, MD, MPH, Cardiovascular Health Research Unit, Metropolitan Park 2 Bldg, Suite 14360, 1730 Minor Avenue, Seattle, WA 98101, USA

Abstract

GISSI-Prevenzione findings provide additional support for the association of dietary intake of long-chain n-3 polyunsaturated fatty acids (PUFAs) from seafood [eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3) with the risk of coronary heart disease (CHD) mortality and sudden cardiac death. The findings also complement evidence from animal-experimental studies, cell biology and dietary intervention trials that suggest that long-chain n-3 PUFAs may protect against the life-threatening ventricular arrhythmias that result in sudden cardiac death.

In this report, we review (1) several issues initially raised in the interpretation of clinical epidemiological studies of the association of long-chain n-3 PUFAs and the risk of CHD and (2) findings from a population-based case-control study of dietary intake and cell-membrane levels of long-chain n-3 PUFAs from seafood and the risk of primary cardiac arrest, that complements the findings from the GISSI-Prevenzione trial. Taken together, the available data supports both the role of low-dose, long-chain n-3 PUFAs in the prevention of sudden cardiac death and further targeted clinical research to examine more fully the effects of lowdose, long-chain n-3 PUFAs on the occurrence of life-threatening ventricular arrhythmias in other clinically defined, high-risk populations.

Key Words: Polyunsaturated fats • fatty acids • cardiac arrest • sudden death • coronary heart disease

Footnotes

Supported by grants from the National Heart, Lung, and Blood Institute (HL41993) and the University of Washington Clinical Nutrition Research Unit (DK-35816). The initial support was provided by the Medic One Foundation, Seattle, Washington.

References

  1. GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSIPrevenzione trial. Gruppo Italiano per to Studio della Sopravvivenza nell'Infarto miocardicoLancet. 1999;354:447–455[CrossRef][Web of Science][Medline]
  2. Bang HO, Dyerberg J, Hjorne N. The composition of food consumed by Greenland Eskimos. Acta Med Scand. 1976;200:69–73[Web of Science][Medline]
  3. Stone NJ. Fish consumption, fish oil, lipids, and coronary heart disease. Circulation. 1996;94:2337–2340[Free Full Text]
  4. Kromhout D, Bosschieter EB, Coulander de LC. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med. 1985;312:1205–1209[Abstract]
  5. Shekelle RB, Missell L, Paul O, Shryock AM, Stamler J. Fish consumption and mortality from coronary heart disease [letter]. N Engl J Med. 1985;313:820[Medline]
  6. Dolecek TA, Grandits G. Dietary polyunsaturated fatty acids and mortality in the Multiple Risk Factor Intervention Trial (MRFIT). World Rev Nutr Diet. 1991;66:205–216[Medline]
  7. Kromhout D, Feskens EJM, Bowles CH. The protective effect of a small amount of fish on coronary heart disease mortality in an elderly population. Int J Epidemiol. 1995;24:340–345[Abstract/Free Full Text]
  8. Norell SE, Ahlbom A, Feychting M, Pedersen NL. Fish consumption and mortality from coronary heart disease. Br Med J. 1986;293:426
  9. Curb JD, Reed DM. Fish consumption and mortality from coronary heart disease [letter]. N Engl J Med. 1985;313:821[Web of Science]
  10. Vollset SE, Heugh I, Bjelke E. Fish consumption and mortality from coronary heart disease [letter]. N Engl J Med. 1985;313:820–821
  11. Morris MC, Manson JE, Rosner B, Buring JE, Willett WC, Hennekens CH. Fish consumption and cardiovascular disease in the physicians health study: a prospective study. Am J Epidemiol. 1995;142:166–175[Abstract/Free Full Text]
  12. Guallar E, Hennekens CH, Sacks FM, Willett WC, Stampfer ML. A prospective study of plasma fish oil levels and incidence of myocardial infarction in US male physicians. J Am Coll Cardiol. 1995;25:387–394[Abstract]
  13. Ascherio A, Rimm E, Stampfer MJ, et al. Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary heart disease among men. N Engl J Med. 1995;332:977–982[Abstract/Free Full Text]
  14. Salonen IT, Nyyssonen K, Salonen R. Fish intake and the risk of coronary disease. N Engl J Med. 1995;333:937[Free Full Text]
  15. Daviglus ML, Stamler J, Orencia AJ, et al. Fish consumption and the 30-year risk of fatal myocardial infarction. N Engl J Med. 1997;336:1046–1053[Abstract/Free Full Text]
  16. Siscovick DS, Raghunathan TE, King I, et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. J Am Med Assoc. 1995;274:1363–1367[Abstract/Free Full Text]
  17. Albert CM, Hennekens CH, O'Donnell CJ, et al. Fish consumption and risk of sudden cardiac death. J Am Med Assoc. 1998;279:23–28[Abstract/Free Full Text]
  18. Katan MB. Fish and heart disease. N Engl J Med. 1995;332:1024–1025[Free Full Text]
  19. Charnock IS. Dietary fats and cardiac arrhythmia in primates. Nutrition. 1994;10:161–169[Web of Science][Medline]
  20. McLennan PL, Bridle TM, Abeywardena MY, et al. Dietary lipid modulation of ventricular fibrillation threshold in the marmoset monkey. Am Heart J. 1992;123:1555–1561[CrossRef][Web of Science][Medline]
  21. McLennan PL, Abeywardena MY, Charnock IS. The influence of age and dietary fat in an animal model of sudden cardiac death. Aust N Z J Med. 1989;19:1–5[Web of Science][Medline]
  22. Charnock IS, Abeywardena MY, Poletti VM, et al. Differences in fatty acid composition of various tissues of the marmoset monkey after different lipid supplemented diets. Comp Biochem Physiol. 1992;101A:387–393[CrossRef]
  23. McLennan PL, Bridle TM, Abeywardena MY, et al. Comparative efficacy of n-3 and n-6 polyunsaturated fatty acids in modulating ventricular fibrillation threshold in marmoset monkeys. Am J Clin Nutr. 1993;58:666–669[Abstract/Free Full Text]
  24. Billman GE, Hallaq H, Leaf A. Prevention of ischemiainduced ventricular fibrillation by n-3 fatty acids. Proc Natl Acad Sci. 1994. p. 4427–4430
  25. Hallaq H, Smith TW, Leaf A. Modulation of dihydropyridine-sensitive calcium channels in heart cells by fish oil fatty acids. Proc Natl Acad Sci. 1992. p. 1760–1764
  26. Pepe S, Bogdanov K, Hallaq H, Spurgeon HA, Leaf A, Lakatta E. Omega-3 polyunsaturated fatty acid modulates dihydropyridine effects on L-type Ca2+ channels, cytosolic Ca2+, and contraction in adult rat cardiac myocytes. Proc Natl Acad Sci. 1994. p. 8832–8836
  27. Kang J, Leaf A. Antiarrhythmic effects of polyunsaturated fatty acids: recent studies. Circulation. 1996;94:1774–1780[Free Full Text]
  28. Xiao Y-F, Kang JX, Morgan JP, Leaf A. Blocking effects of polyunsaturated fatty acids on Na+ channels in neonatal rat ventricular myocytes. Proc Natl Acad Sci USA. 1995. p. 1100–1104
  29. Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet. 1989;334:757–761[CrossRef]
  30. Lorgeril MD, Mamelle N, Salen P, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343:1454–1459[CrossRef][Web of Science][Medline]
  31. Siscovick DS, Raghunathan TE, King I, et al. Dietary intake of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. Am J Clin Nutr. 2000;71:208S–212S (Suppl)[Abstract/Free Full Text]
  32. Nutrition Monitoring Division, Human Nutrition Information Services. Composition of Foods: Finfish and Shellfish Products. United States Department of Agriculture Handbook. 1987;(Number 8–15):
  33. Hu FB, Stampfer ML, Manson JE, et al. Dietary intake of alpha-linolenic acid and risk of fatal ischemic heart disease among women. Am J Clin Nutr. 1999;69:890–897[Abstract/Free Full Text]

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 Siscovick, D.S.
Right arrow Articles by Cobb, L.A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Siscovick, D.S.
Right arrow Articles by Cobb, L.A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?