Effects of Omega-3 Fatty Acids in Myocardial Infarction
Omega-3 polyunsaturated fatty acids (n-3 PUFAs) from fish and fish oils can protect against cardiovascular disease (CVD), which is still the most common cause of mortality and morbidity worldwide. To reduce CVD risk, integral lifestyle modifications, such
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Sang Yeoup Lee, Yu Hyeon Yi, and Young Jin Tak
Introduction Cardiovascular disease (CVD) is a global health problem, leading to the cause of mortality and morbidity worldwide [1]. Myocardial infarction (MI) is defined pathologically as myocardial cell necrosis caused by significant and sustained ischemia [2]. MI results from either coronary heart disease, which implies obstruction of blood flow due to plaque in coronary arteries, or much less frequently, to other obstructing mechanisms (e.g., spasm of plaque-free arteries). Plaque is a consequence of atherosclerosis, which is a major contributor to the pathogenesis of CVD. To reduce CVD risk, lifestyle modifications, such as smoking cessation, moderate alcohol consumption, exercise, stress reduction, weight control, and diet, are needed. Furthermore, these factors contribute synergistically to prevent CVD [3–6]. Regarding diet, several authors have attempted to clarify the mechanisms responsible for the atheroprotective effects of n-3 polyunsaturated fatty acids (n-3 PUFAs). Dietary n-3 PUFAs, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are present in fish meat and oils.
S.Y. Lee (&) Family Medicine Clinic and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan, Gyeongsangnam-do 626-770, South Korea e-mail: [email protected] S.Y. Lee Medical Education Unit, Pusan National University School of Medicine, Yangsan, South Korea
Furthermore, the percentage of EPA plus DHA in erythrocyte membrane fatty acids is an index of systemic n-3 PUFA status, the omega-3 index [7]. Asians consume more fish than Caucasians and have omega-3 indices more than two times greater. Nevertheless, CVD occurs in Asians, although its prevalence is lower. The mechanisms responsible for the anti-atherosclerotic and anti-thrombotic effects of n-3 PUFAs have not been determined, but several studies conducted over the last three decades have attempted to clarify the mechanisms involved. N-3 PUFAs lower serum triglyceride levels, improve endothelial function, have anti-thrombogenic effects, reduce adhesion molecule and inflammatory mediator levels by regulating their gene expressions or by promoting their transformations to downstream metabolites, and increase the stability of atherosclerotic plaque [8–11]. Ever since it was reported in 1970 that Greenland Eskimos have a low cardiovascular (CV) mortality rate, epidemiologic studies have suggested that n-3 PUFAs play a role in the prevention of CVD [8]. Recent intravascular ultrasound studies have shown inverse associations between n-3 PUFA blood levels and the development of vulnerable plaque and atheroma progression in patients that attained low-density lipoprotein cholesterol goals of less than 100 mg/d on statin therapy [12–14]. Furthermore, several trials have shown significant CV benefits for dietary n-3 PUFAs in patients at high risk of CVD, such as in patients that experienced MI within 3 months of study enrollment [15–17], alt
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