Journal of Medicine and Life Science

Institute for Medical Science (제주대학교 의과학연구소)
권호 표지
DOI QR코드

DOI QR Code

Effects of omega-3 fatty acids, vitamins, and chelation therapy in patients with heart diseases

심질환 환자에서 오메가-3 지방산, 비타민, 킬레이션 요법의 효과

  • Joo, Seung-Jae (Department of Cardiology, Jeju National University Hospital)
  • 주승재 (제주대학교병원 심장내과)
  • Received : 2020.12.26
  • Accepted : 2021.03.07
  • Published : 2021.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Omega-3 fatty acids (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) may be beneficial for the primary and secondary prevention of cardiovascular events (CVEs), especially in patients with myocardial infarction or heart failure with reduced ejection fraction. For this purpose, one to two seafood meals per week is preferentially recommended. Omega-3 fatty acids with a high-dose EPA formula (4 g/day) may be more effective than EPA+DHA mixed supplements for the secondary prevention of CVE. Krill oil also contains omega-3 fatty acids, but at a much lower dose compared to fish oil. Supplemental vitamins and minerals have not shown the preventive effects on CVE in prospective, and randomized clinical trials, except for one Chinese study showing the stroke prevention effects of folic acid. The clinical benefit of chelation therapy in reducing CVEs is uncertain.

Keywords

References

  1. Korea National Health & Nutrition Examination Survey (KDCA). 2018 National Health Statistics [Internet]. Cheongju: KDCA; c2020 [cited 2020 Nov 1]. Available from: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7.
  2. Zhang FF, Barr SI, McNulty H, Li D, Blumberg JB. Health effects of vitamin and mineral supplements. BMJ 2020;369:m2511.
  3. Kang M, Kim DW, Baek YJ, Moon SH, Jung HJ, Song YJ, et al. Dietary supplement use and its effect on nutrient intake in Korean adult population in the Korea National Health and Nutrition Examination Survey IV (2007-2009) data. Eur J Clin Nutr 2014;68:804-10. https://doi.org/10.1038/ejcn.2014.77
  4. Mozaffarian D, Wu JH. Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol 2011;58:2047-67. https://doi.org/10.1016/j.jacc.2011.06.063
  5. Innes JK, Calder PC. Marine omega-3 (N-3) fatty acids for cardiovascular health: an update for 2020. Int J Mol Sci 2020;21:1362. https://doi.org/10.3390/ijms21041362
  6. Sakamoto A, Saotome M, Iguchi K, Maekawa Y. Marine-derived omega-3 polyunsaturated fatty acids and heart failure: current understanding for basic to clinical relevance. Int J Mol Sci 2019;20:4025. https://doi.org/10.3390/ijms20164025
  7. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007;369:1090-8. https://doi.org/10.1016/S0140-6736(07)60527-3
  8. ASCEND Study Collaborative Group, Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, et al. Effects of n-3 fatty acid supplements in diabetes mellitus. N Engl J Med 2018;379:1540-50. https://doi.org/10.1056/NEJMoa1804989
  9. Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, et al. Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. N Engl J Med 2019;380:23-32. https://doi.org/10.1056/NEJMoa1811403
  10. Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 1989;2:757-61.
  11. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. Lancet 1999;354:447-55.
  12. Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation 2002;105:1897-903. https://doi.org/10.1161/01.CIR.0000014682.14181.F2
  13. Tavazzi L, Maggioni AP, Marchioli R, Barlera S, Franzosi MG, Latini R, et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 2008;372:1223-30. https://doi.org/10.1016/S0140-6736(08)61239-8
  14. Kromhout D, Giltay EJ, Geleijnse JM; Alpha Omega Trial Group. n-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med 2010;363:2015-26. https://doi.org/10.1056/NEJMoa1003603
  15. Rauch B, Schiele R, Schneider S, Diller F, Victor N, Gohlke H, et al. OMEGA, a randomized, placebo-controlled trial to test the effect of highly purified omega-3 fatty acids on top of modern guideline-adjusted therapy after myocardial infarction. Circulation 2010;122:2152-9. https://doi.org/10.1161/CIRCULATIONAHA.110.948562
  16. Galan P, Kesse-Guyot E, Czernichow S, Briancon S, Blacher J, Hercberg S, et al. Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo controlled trial. BMJ 2010;341:c6273. https://doi.org/10.1136/bmj.c6273
  17. ORIGIN Trial Investigators, Bosch J, Gerstein HC, Dagenais GR, Diaz R, Dyal L, et al. n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med 2012;367:309-18. https://doi.org/10.1056/NEJMoa1203859
  18. Risk and Prevention Study Collaborative Group, Roncaglioni MC, Tombesi M, Avanzini F, Barlera S, Caimi V, et al. n-3 fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med 2013;368:1800-8. https://doi.org/10.1056/NEJMoa1205409
  19. Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 2019;380:11-22. https://doi.org/10.1056/NEJMoa1812792
  20. Hu Y, Hu FB, Manson JE. Marine omega-3 supplementation and cardiovascular disease: an updated meta-analysis of 13 randomized controlled trials involving 127 477 participants. J Am Heart Assoc 2019;8:e013543.
  21. Nicholls SJ, Lincoff AM, Garcia M, Bash D, Ballantyne CM, Barter PJ, et al. Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the STRENGTH randomized clinical trial. JAMA 2020;324:2268-80. https://doi.org/10.1001/jama.2020.22258
  22. Kalstad AA, Myhre PL, Laake K, Tveit SH, Schmidt EB, Smith P, et al. Effects of n-3 fatty acid supplements in elderly patients after myocardial infarction: a randomized, controlled trial. Circulation 2021;143:528-39. https://doi.org/10.1161/CIRCULATIONAHA.120.052209
  23. Mason RP, Libby P, Bhatt DL. Emerging mechanisms of cardiovascular protection for the omega-3 fatty acid eicosapentaenoic acid. Arterioscler Thromb Vasc Biol 2020;40:1135-47. https://doi.org/10.1161/ATVBAHA.119.313286
  24. Backes JM, Howard PA. Krill oil for cardiovascular risk prevention: is it for real? Hosp Pharm 2014;49:907-12. https://doi.org/10.1310/hpj4910-907
  25. Ursoniu S, Sahebkar A, Serban MC, Antal D, Mikhailidis DP, Cicero A, et al. Lipid-modifying effects of krill oil in humans: systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2017;75:361-73. https://doi.org/10.1093/nutrit/nuw063
  26. Laidlaw M, Cockerline CA, Rowe WJ. A randomized clinical trial to determine the efficacy of manufacturers' recommended doses of omega-3 fatty acids from different sources in facilitating cardiovascular disease risk reduction. Lipids Health Dis 2014;13:99. https://doi.org/10.1186/1476-511X-13-99
  27. Rimm EB, Appel LJ, Chiuve SE, Djousse L, Engler MB, Kris-Etherton PM, et al. Seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease: a science advisory from the American Heart Association. Circulation 2018;138:e35-47.
  28. Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA 2006;296:1885-99. https://doi.org/10.1001/jama.296.15.1885
  29. Siscovick DS, Barringer TA, Fretts AM, Wu JH, Lichtenstein AH, Costello RB, et al. Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: a science advisory from the American Heart Association. Circulation 2017;135:e867-84.
  30. Skulas-Ray AC, Wilson PWF, Harris WS, Brinton EA, Kris-Etherton PM, Richter CK, et al. Omega-3 fatty acids for the management of hypertriglyceridemia: a science advisory from the American Heart Association. Circulation 2019;140:e673-91.
  31. Sunkara A, Raizner A. Supplemental vitamins and minerals for cardiovascular disease prevention and treatment. Methodist Debakey Cardiovasc J 2019;15:179-84.
  32. Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, et al. Multivitamins in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial. JAMA 2012;308:1751-60. https://doi.org/10.1001/jama.2012.14805
  33. Jenkins DJA, Spence JD, Giovannucci EL, Kim YI, Josse R, Vieth R, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol 2018;71:2570-84. https://doi.org/10.1016/j.jacc.2018.04.020
  34. Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, et al. The SU.VI.MAX study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 2004;164:2335-42. https://doi.org/10.1001/archinte.164.21.2335
  35. Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA 2005;294:56-65. https://doi.org/10.1001/jama.294.1.56
  36. Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA 2005;293:1338-47. https://doi.org/10.1001/jama.293.11.1338
  37. Lonn E, Yusuf S, Arnold MJ, Sheridan P, Pogue J, Micks M, et al. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med 2006;354:1567-77. https://doi.org/10.1056/NEJMoa060900
  38. Huo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA 2015;313:1325-35. https://doi.org/10.1001/jama.2015.2274
  39. AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, et al. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med 2011;365:2255-67. https://doi.org/10.1056/NEJMoa1107579
  40. HPS2-THRIVE Collaborative Group, Landray MJ, Haynes R, Hopewell JC, Parish S, Aung T, et al. Effects of extended-release niacin with laropiprant in high-risk patients. N Engl J Med 2014;371:203-12. https://doi.org/10.1056/NEJMoa1300955
  41. Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med 2019;380:33-44. https://doi.org/10.1056/NEJMoa1809944
  42. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012;126:e354-471.
  43. Lamas GA, Navas-Acien A, Mark DB, Lee KL. Heavy metals, cardiovascular disease, and the unexpected benefits of chelation therapy. J Am Coll Cardiol 2016;67:2411-8. https://doi.org/10.1016/j.jacc.2016.02.066
  44. Lamas GA, Goertz C, Boineau R, Mark DB, Rozema T, Nahin RL, et al. Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial. JAMA 2013;309:1241-50. https://doi.org/10.1001/jama.2013.2107
  45. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2014;130:1749-67. https://doi.org/10.1161/CIR.0000000000000095
  46. Villarruz-Sulit MV, Forster R, Dans AL, Tan FN, Sulit DV. Chelation therapy for atherosclerotic cardiovascular disease. Cochrane Database Syst Rev 2020;5:CD002785.