Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Effect of n-3 Polyunsaturated Fatty Acids on Regression of Coronary Atherosclerosis in Statin Treated Patients Undergoing Percutaneous Coronary Intervention

  • Ahn, Jinhee (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital) ;
  • Park, Seo Kwang (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital) ;
  • Park, Tae Sik (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital) ;
  • Kim, Jin Hee (Department of Internal Medicine, Busan Medical Center) ;
  • Yun, Eunyoung (Department of Biostatistics, Pusan National University Hospital) ;
  • Kim, Sang-Pil (Department of Cardiovascular Surgery, Pusan National University Hospital) ;
  • Lee, Hye Won (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital) ;
  • Oh, Jun-Hyok (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital) ;
  • Choi, Jung Hyun (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital) ;
  • Cha, Kwang Soo (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital) ;
  • Hong, Taek Jong (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital) ;
  • Lee, Sang Yeoup (Family Medicine Clinic and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Lee, Han Cheol (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital)
  • Received : 2015.07.15
  • Accepted : 2015.10.13
  • Published : 2016.07.30
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Abstract

Background and Objectives: Statins remain the mainstay of secondary coronary artery disease (CAD) prevention, but n-3 polyunsaturated fatty acids (${\omega}-3$ PUFA) display biological effects that may also reduce the risk of atherosclerosis and CAD. However, data on the possible antiatherosclerotic benefits of adding ${\omega}-3$ PUFA to statin therapy are limited. This study aimed to investigate the potential additive effects of ${\omega}-3$ PUFA on regression of atherosclerosis in CAD patients receiving statin therapy and stent implantation. Subjects and Methods: Seventy-four CAD patients undergoing percutaneous coronary intervention (PCI) with stent implantation were enrolled, prescribed statins, and randomly assigned to two groups: n-3 group (${\omega}-3$ PUFA 3 g/day, n=38) or placebo group (placebo, n=36). All patients completed the study follow-up consisting of an intravascular ultrasound at baseline and at 12 months. Results: There was no difference in the baseline characteristics and distribution of other medications. No significant differences were observed in primary endpoints, including changes in atheroma volume index (-12.65% vs. -8.51%, p=0.768) and percent atheroma volume (-4.36% vs. -9.98%, p=0.526), and in secondary endpoints including a change in neointimal volume index (7.84 vs. $4.94mm^3/mm$, p=0.087). Conclusion: ${\omega}-3$ PUFA had no definite additional effect on the regression of coronary atherosclerosis when added to statin in CAD patients undergoing PCI.

Keywords

Acknowledgement

Supported by : Pusan National University Hospital

References

  1. Kris-Etherton PM, Harris WS, Appel LJ; American Heart Association. Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002;106:2747-57. https://doi.org/10.1161/01.CIR.0000038493.65177.94
  2. Cawood AL, Ding R, Napper FL, et al. Eicosapentaenoic acid (EPA) from highly concentrated n-3 fatty acid ethyl esters is incorporated into advanced atherosclerotic plaques and higher plaque EPA is associated with decreased plaque inflammation and increased stability. Atherosclerosis 2010;212:252-9. https://doi.org/10.1016/j.atherosclerosis.2010.05.022
  3. 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
  4. Amano T, Matsubara T, Uetani T, et al. Impact of omega-3 polyunsaturated fatty acids on coronary plaque instability: An integrated backscatter intravascular ultrasound study. Atherosclerosis 2011;218:110-6. https://doi.org/10.1016/j.atherosclerosis.2011.05.030
  5. Nozue T, Yamamoto S, Tohyama S, et al. A predictor of atheroma progression in patients achieving very low levels of low-density lipoprotein cholesterol. Am J Cardiovasc Dis 2013;3:255-63.
  6. ORIGIN Trial Investigators, Bosch J, Gerstein HC. 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
  7. Rauch B, Schiele R, Schneider S, 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
  8. Wu JH, Mozaffarian D. ${\omega}$-3 fatty acids, atherosclerosis progression and cardiovascular outcomes in recent trials: new pieces in a complex puzzle. Heart 2014;100:530-3. https://doi.org/10.1136/heartjnl-2013-305257
  9. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's principles of Internal Medicine. 18th ed. New York: McGrawHill; 2012. p.1983-91.
  10. Chang CL, Seo T, Du CB, Accili D, Deckelbaum RJ. n-3 fatty acids decrease arterial low-density lipoprotein cholesterol delivery and lipoprotein lipase levels in insulin-resistant mice. Arterioscler Thromb Vasc Biol 2010;30:2510-7. https://doi.org/10.1161/ATVBAHA.110.215848
  11. Talayero BG, Sacks FM. The role of triglycerides in atherosclerosis. Curr Cardiol Rep 2011;13:544-52. https://doi.org/10.1007/s11886-011-0220-3
  12. Calder PC. n-3 fatty acids and cardiovascular disease: evidence explained and mechanisms explored. Clin Sci (Lond) 2004;107:1-11. https://doi.org/10.1042/CS20040119
  13. Massaro M, Scoditti E, Carluccio MA, De Caterina R. Nutraceuticals and prevention of atherosclerosis: focus on omega-3 polyunsaturated fatty acids and Mediterranean diet polyphenols. Cardiovasc Ther 2010;28:e13-9. https://doi.org/10.1111/j.1755-5922.2010.00211.x
  14. Nakajima K, Yamashita T, Kita T, et al. Orally administered eicosapentaenoic acid induces rapid regression of atherosclerosis via modulating the phenotype of dendritic cells in LDL receptor-deficient mice. Arterioscler Thromb Vasc Biol 2011;31:1963-72. https://doi.org/10.1161/ATVBAHA.111.229443
  15. O'Keefe JH Jr, Abuissa H, Sastre A, Steinhaus DM, Harris WS. Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions. Am J Cardiol 2006;97:1127-30. https://doi.org/10.1016/j.amjcard.2005.11.025
  16. Charnock JS, McLennan PL, Abeywardena MY. Dietary modulation of lipid metabolism and mechanical performance of the heart. Mol Cell Biochem 1992;116:19-25. https://doi.org/10.1007/BF01270564
  17. Djousse L, Gaziano JM, Buring JE, Lee IM. Dietary omega-3 fatty acids and fish consumption and risk of type 2 diabetes. Am J Clin Nutr 2011;93:143-50. https://doi.org/10.3945/ajcn.110.005603
  18. Leon H, Shibata MC, Sivakumaran S, Dorgan M, Chatterley T, Tsuyuki RT. Effect of fish oil on arrhythmias and mortality: systematic review. BMJ 2008;337:a2931. https://doi.org/10.1136/bmj.a2931
  19. Marik PE, Varon J. Omega-3 dietary supplements and the risk of cardiovascular events: a systematic review. Clin Cardiol 2009;32:365-72. https://doi.org/10.1002/clc.20604
  20. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366:1267-78. https://doi.org/10.1016/S0140-6736(05)67394-1
  21. 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. https://doi.org/10.1016/S0140-6736(99)07072-5
  22. Nissen SE, Nicholls SJ, Sipahi I, et al. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006;295:1556-65. https://doi.org/10.1001/jama.295.13.jpc60002
  23. Lee E, Lee S, Park Y. n-3 polyunsaturated fatty acids and trans fatty acids in patients with the metabolic syndrome: a case-control study in Korea. Br J Nutr 2008;100:609-14. https://doi.org/10.1017/S0007114508925435
  24. Casula M, Soranna D, Catapano AL, Corrao G. Long-term effect of high dose omega-3 fatty acid supplementation for secondary prevention of cardiovascular outcomes: a meta-analysis of randomized, placebo controlled trials. Atherosclerosis Suppl 2013;14:243-51. https://doi.org/10.1016/S1567-5688(13)70005-9
  25. GISSI-HF investigators, Tavazzi L, Maggioni AP, 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
  26. Maki KC, Orloff DG, Nicholls SJ, et al. A highly bioavailable omega-3 free fatty acid formulation improves the cardiovascular risk profile in high-risk, statin-treated patients with residual hypertriglyceridemia (the ESPRIT trial). Clin Ther 2013;35:1400-11.e1-3. https://doi.org/10.1016/j.clinthera.2013.07.420
  27. Burr ML, Ashfield-Watt PA, Dunstan FD, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr 2003;57:193-200. https://doi.org/10.1038/sj.ejcn.1601539
  28. 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
  29. Arnesen H. n-3 fatty acids and revascularization procedures. Lipids 2001;36 Suppl:S103-6. https://doi.org/10.1007/s11745-001-0690-z

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