About the controversies of the cardioprotective effect of n-3 polyunsaturated fatty acids (PUFAs) between animal studies
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ORIGINAL ARTICLE
About the controversies of the cardioprotective effect of n-3 polyunsaturated fatty acids (PUFAs) between animal studies and clinical meta-analyses: a review with several strategies to enhance the beneficial effects of n-3 PUFAs Luc Demaison 1
&
Thibault Leger 1 & Catherine Vergely 2 & Luc Rochette 2 & Kasra Azarnoush 3
Received: 4 September 2018 / Accepted: 21 February 2019 # University of Navarra 2019
Abstract Several meta-analyses describing the effect of n-3 polyunsaturated fatty acids on the survival rate of the victims of an acute coronary event do not clearly support a beneficial impact of these fatty acids. Yet, animal studies consistently show n-3 PUFA– induced protection against ischemia-reperfusion-induced myocardial injuries. The impact on reperfusion arrhythmias of these PUFAs is more controversial. The literature shows the anti-arrhythmic properties of circulating n-3 PUFAs. However, when these fatty acids are incorporated in the cardiac membrane, they protect the myocardial tissue vis a vis cellular damage but they can be either pro- or anti-arrhythmic during reperfusion, depending on the severity of tissue injuries. The latter elements can explain the lack of beneficial effect observed in the meta-analyses, but a proper use of n-3 PUFAs may provide advantages in terms of survival rate. This review discusses the different results obtained in humans and animals and presents several strategies to enhance the beneficial effects of n-3 PUFAs. Keywords N-3 PUFAs . Heart . Infarction . Cellular damages . Arrhythmias . Cardiac death
Introduction In industrialized societies and numerous emerging countries, a large portion of the population eats what is called a Western diet. This diet is characterized, among other things, by a too large n-6 polyunsaturated fatty acid (PUFAs) supply and a too low n-3 PUFAs intake [1]. Several meta-analyses have indicated that cardiovascular disease–related mortality and sudden death are * Luc Demaison [email protected] 1
INRA, UNH, Unité de Nutrition Humaine, Université Clermont Auvergne, CRNH Auvergne, 63000 Clermont-Ferrand, France
2
Research team Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2, EA7460), University of Bourgogne Franche-Comté, UFR des Sciences de Santé, Dijon, France
3
Heart Surgery Department, G. Montpied Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
decreased by n-3 polyunsaturated fatty acids (PUFAs) [2–4]. However, other meta-analyses have not observed any beneficial effects on these endpoints [5, 6]. The discrepancies can result from the nature of the chosen n-3 PUFAs, the doses used, and/or the duration of the treatments. They can also result from the selection of clinical trials included in the different meta-analyses, some of them being considered reliable and others not credible. Thus, the cardioprotective effect of n-3 PUFAs on survival after a cardiac event is far from being obvious in the light of the published meta-analyses [7]. Cardiac-related mortality mainly
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