Open AccessThe journey of omega-3 fatty acids in cardiovascular medicine
Author(s) -
Roberto Ferrari,
Stefano Censi,
Paolo Cimaglia
Publication year - 2020
Publication title -
european heart journal supplements
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.389
H-Index - 36
eISSN - 1554-2815
pISSN - 1520-765X
DOI - 10.1093/eurheartj/suaa118
Subject(s) - medicine , hypertriglyceridemia , myocardial infarction , aspirin , polyunsaturated fatty acid , adverse effect , sudden cardiac death , cardiology , fatty acid , cholesterol , triglyceride , biochemistry , chemistry
In subjects with cardiovascular risk factors or in patients in need of secondary prevention, hypertriglyceridemia is a well-defined risk factor for adverse cardiac events. Drugs containing n-3 polyunsaturated fatty acids (n-3 PUFAs) are approved for treatment of hypertriglyceridemia. In 1999, a cardioprotective effect in post infarct patients was suggested by a large multicentre study, the GISSI prevention trial. The hypothesized mechanism of action was an antiarrhythmic action leading to reduction of the sudden death. However, such a cardioprotective effect of n-3 PUFAs has not been straightforward like for other cardiovascular drugs such as aspirin, statins or ACE inhibitors. On the contrary, it has been a long journey with several ups and downs. Recently, the European Medicines Agency (EMA) has not confirmed the risk benefit of low dose of n-3 PUFA in preventing outcomes after a myocardial infarction. Since the EMA decision, the use of a high dose (4g daily) of pure and stable EPA in a multicentre, international trial, the REDUCE-IT study showed a clear cardiovascular event reduction which was not confirmed in another trial, the STRENGTH study, which utilized 4g daily of an EPA+DHA mixture. It follows that the OMEGA-3 fatty acid story seems to be endless and the last word on cardiovascular benefits cannot be pronounced. We report a brief narrative of an entire journey from the beginning to nowadays.