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      Limited Impact of 2 g/day Omega-3 Fatty Acid Ethyl Esters (Omacor ®) on Plasma Lipids and Inflammatory Markers in Patients Awaiting Carotid Endarterectomy

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          Abstract

          The objective of this study was to determine the effects of prescription omega-3 ( n-3) fatty acid ethyl esters (Omacor ®) on blood pressure, plasma lipids, and inflammatory marker concentrations in patients awaiting carotid endarterectomy. Patients awaiting carotid endarterectomy ( n = 121) were randomised to Omacor ® or olive oil as placebo (2 g/day) until surgery (median 21 days). Blood pressure, plasma lipids, and plasma inflammatory markers were determined. There were significant decreases in systolic and diastolic blood pressure and in plasma triglyceride, total cholesterol, low density lipoprotein-cholesterol, soluble vascular cellular adhesion molecule 1, and matrix metalloproteinase 2 concentrations, in both groups. The extent of triglyceride lowering was greater with Omacor ® (25%) compared with placebo (9%). Soluble E-selectin concentration was significantly decreased in the Omacor ® group but increased in the placebo group. At the end of the supplementation period there were no differences in blood pressure or in plasma lipid and inflammatory marker concentrations between the two groups. It is concluded that Omacor ® given at 2 g/day for an average of 21 days to patients with advanced carotid atherosclerosis lowers triglycerides and soluble E-selectin concentrations, but has limited broad impact on the plasma lipid profile or on inflammatory markers. This may be because the duration of intervention was too short or the dose of n-3 fatty acids was too low.

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          Blood levels of long-chain n-3 fatty acids and the risk of sudden death.

          Experimental data suggest that long-chain n-3 polyunsaturated fatty acids found in fish have antiarrhythmic properties, and a randomized trial suggested that dietary supplements of n-3 fatty acids may reduce the risk of sudden death among survivors of myocardial infarction. Whether long-chain n-3 fatty acids are also associated with the risk of sudden death in those without a history of cardiovascular disease is unknown. We conducted a prospective, nested case-control analysis among apparently healthy men who were followed for up to 17 years in the Physicians' Health Study. The fatty-acid composition of previously collected blood was analyzed by gas-liquid chromatography for 94 men in whom sudden death occurred as the first manifestation of cardiovascular disease and for 184 controls matched with them for age and smoking status. Base-line blood levels of long-chain n-3 fatty acids were inversely related to the risk of sudden death both before adjustment for potential confounders (P for trend = 0.004) and after such adjustment (P for trend = 0.007). As compared with men whose blood levels of long-chain n-3 fatty acids were in the lowest quartile, the relative risk of sudden death was significantly lower among men with levels in the third quartile (adjusted relative risk, 0.28; 95 percent confidence interval, 0.09 to 0.87) and the fourth quartile (adjusted relative risk, 0.19; 95 percent confidence interval, 0.05 to 0.71). The n-3 fatty acids found in fish are strongly associated with a reduced risk of sudden death among men without evidence of prior cardiovascular disease.
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            Fish and omega-3 fatty acid intake and risk of coronary heart disease in women.

            Frank Hu (2002)
            Higher consumption of fish and omega-3 fatty acids has been associated with a lower risk of coronary heart disease (CHD) in men, but limited data are available regarding women. To examine the association between fish and long-chain omega-3 fatty acid consumption and risk of CHD in women. Dietary consumption and follow-up data from 84 688 female nurses enrolled in the Nurses' Health Study, aged 34 to 59 years and free from cardiovascular disease and cancer at baseline in 1980, were compared from validated questionnaires completed in 1980, 1984, 1986, 1990, and 1994. Incident nonfatal myocardial infarction and CHD deaths. During 16 years of follow-up, there were 1513 incident cases of CHD (484 CHD deaths and 1029 nonfatal myocardial infarctions). Compared with women who rarely ate fish (<1 per month), those with a higher intake of fish had a lower risk of CHD. After adjustment for age, smoking, and other cardiovascular risk factors, the multivariable relative risks (RRs) of CHD were 0.79 (95% confidence interval [CI], 0.64-0.97) for fish consumption 1 to 3 times per month, 0.71 (95% CI, 0.58-0.87) for once per week, 0.69 (95% CI, 0.55-0.88) for 2 to 4 times per week, and 0.66 (95% CI, 0.50-0.89) for 5 or more times per week (P for trend =.001). Similarly, women with a higher intake of omega-3 fatty acids had a lower risk of CHD, with multivariable RRs of 1.0, 0.93, 0.78, 0.68, and 0.67 (P<.001 for trend) across quintiles of intake. For fish intake and omega-3 fatty acids, the inverse association appeared to be stronger for CHD deaths (multivariate RR for fish consumption 5 times per week, 0.55 [95% CI, 0.33-0.90] for CHD deaths vs 0.73 [0.51-1.04]) than for nonfatal myocardial infarction. Among women, higher consumption of fish and omega-3 fatty acids is associated with a lower risk of CHD, particularly CHD deaths.
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              Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies.

              Results from observational studies on fish consumption and coronary heart disease (CHD) mortality are inconsistent. A meta-analysis of cohort studies was conducted to examine the association between fish intake and CHD mortality. Studies were included if they provided a relative risk (RR) and corresponding 95% CI for CHD mortality in relation to fish consumption and the frequency of fish intake. A database was developed on the basis of 11 eligible studies and 13 cohorts, including 222 364 individuals with an average 11.8 years of follow-up. Pooled RR and 95% CI for CHD mortality were calculated by using both fixed-effect and random-effect models. A linear regression analysis of the log RR weighted by the inverse of variance was performed to assess the possible dose-response relation. Compared with those who never consumed fish or ate fish less than once per month, individuals with a higher intake of fish had lower CHD mortality. The pooled multivariate RRs for CHD mortality were 0.89 (95% CI, 0.79 to 1.01) for fish intake 1 to 3 times per month, 0.85 (95% CI, 0.76 to 0.96) for once per week, 0.77 (95% CI, 0.66 to 0.89) for 2 to 4 times per week, and 0.62 (95% CI, 0.46 to 0.82) for 5 or more times per week. Each 20-g/d increase in fish intake was related to a 7% lower risk of CHD mortality (P for trend=0.03). These results indicate that fish consumption is inversely associated with fatal CHD. Mortality from CHD may be reduced by eating fish once per week or more.
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                Author and article information

                Journal
                Mar Drugs
                Mar Drugs
                marinedrugs
                Marine Drugs
                MDPI
                1660-3397
                20 September 2013
                September 2013
                : 11
                : 9
                : 3569-3581
                Affiliations
                [1 ]Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; E-Mails: abbie.cawood@ 123456nutricia.com (A.L.C.); rending03@ 123456yahoo.co.uk (R.D.); jenny.williams2@ 123456uhs.nhs.uk (J.A.W.); flnapper@ 123456hotmail.co.uk (F.L.N.); c.p.shearman@ 123456soton.ac.uk (C.P.S.); r.f.grimble@ 123456soton.ac.uk (R.F.G.); P.C.Calder@ 123456soton.ac.uk (P.C.C.)
                [2 ]Department of Food Science, Universiti Malaysia Terengganu, 21030 Kuala Terengganu, Malaysia
                [3 ]Department of Vascular Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK; E-Mail: simon.payne@ 123456porthosp.nhs.uk
                [4 ]National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
                Author notes
                [* ] Author to whom correspondence should be addressed; E-Mail: hayatimy@ 123456umt.edu.my ; Tel.: +60-966-849-61; Fax: +60-966-849-49.
                Article
                marinedrugs-11-03569
                10.3390/md11093569
                3806474
                24065166
                9b1cc45b-8330-4363-8dc1-d0c63fb84823
                © 2013 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                : 17 June 2013
                : 14 August 2013
                : 23 August 2013
                Categories
                Article

                Pharmacology & Pharmaceutical medicine
                omega-3,fish oil,cytokine,adhesion molecule,cardiovascular disease

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