Omega-3-Fettsäuren bei Herzinsuffizienz

 

 Buy Article Permissions and Reprints

Zusammenfassung

Herzinsuffizienz ist der häufigste Grund für Krankenhausaufnahmen in Deutschland. Die beiden Omega-3-Fettsäuren Eicosapentaensäure (EPA) und Docosahexaensäure (DHA) aus Meeresfisch und ähnlichen Quellen, nicht aber die pflanzliche Alpha-Linolensäure, werden in den Leitlinien bei Herzinsuffizienz mit eingeschränkter linksventrikulärer Funktion empfohlen. Die Empfehlungen basieren auf Epidemiologie, Wirkmechanismen und einer großen Interventionsstudie mit klinischen Endpunkten. Die Aufnahme von EPA und DHA ist von Person zu Person sehr variabel, und die klinischen Wirkungen korrelieren nicht mit der Dosis, sondern mit ihren Spiegeln in Erythrozyten. Daher empfiehlt sich eine zielgerichtete Therapie auf Basis einer standardisierten Fettsäureanalytik der Erythrozyten, die auch bei Herzinsuffizienz die umfangreichste wissenschaftliche Datenbasis hat: der HS-Omega-3 Index^® mit einem Zielbereich von 8–11 %.

Abstract

Congestive heart failure is the most frequent cause for hospital admissions in Germany. The two Omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from the sea, but not plant-derived alpha-linolenic acid, are recommended in guidelines for congestive heart failure with reduced ejection fraction. These recommendations are based on epidemiology, mechanisms of action and a large intervention trial with clinical endpoints. From person to person, uptake of EPA and DHA is highly variable, and clinical effects do not correlate with dose, but rather with their levels in erythrocytes. Therefore, a targeted therapy, based on a standardized analysis of erythrocyte fatty acids that has the largest scientific database also in congestive heart failure is recommended: a HS-Omega-3 Index^® with a target range of 8–11 %

• Literatur

• 1 Aleksova A, Masson S, Maggioni AP. et al. n-3 polyunsaturated fatty acids and atrial fibrillation in patients with chronic heart failure: the GISSI-HF trial. Eur J Heart Fail 2013; 15: 1289-95
  CrossrefPubMedGoogle Scholar
• 2 Archer E, Hand GA, Blair SN. Validity of U.S. nutritional surveillance: National Health and Nutrition Examination Survey caloric energy intake data, 1971–2010. PLoS One 2013; 8 e76632
  PubMedGoogle Scholar
• 3 Calder PC. Marine omega-3 fatty acids and inflammatory processes: Effects, mechanisms and clinical relevance. Biochim Biophys Acta 2015; 1851: 469-84
  CrossrefPubMedGoogle Scholar
• 4 Carney RM, Freedland KE, Stein PK. et al. Effect of Omega-3 Fatty Acids on Heart Rate Variability in Depressed Patients with Coronary Heart Disease. Psychosom Med 2010; 72: 748-54
  CrossrefPubMedGoogle Scholar
• 5 Christensen JH. Omega-3 polyunsaturated Fatty acids and heart rate variability. Front Physiol 2011; Nov 16 2: 84 doi: 10.3389/fphys.2011.00084. eCollection 2011
  CrossrefPubMedGoogle Scholar
• 6 Cowie MR, Cure S, Bianic F. et al. Cost-effectiveness of highly purified omega-3 polyunsaturated fatty acid ethyl esters in the treatment of chronic heart failure: results of Markov modelling in a UK setting. Eur J Heart Fail 2011; 13: 681-9
  CrossrefPubMedGoogle Scholar
• 7 De Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: A systematic review. Clin Nutr 2015; 34: 359-66
  CrossrefPubMedGoogle Scholar
• 8 Destatis, Statistisches Bundesamt. Krankenhauspatienten. Vollstationär behandelte Patientinnen und Patienten (einschließlich Sterbe- und Stundenfälle) in Krankenhäusern nach der ICD-10 im Jahr 2015. Statistisches Bundesamt. https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Krankenhaeuser/Tabellen/20DiagnosenInsgesamt.html Stand 08.06.17
  PubMedGoogle Scholar
• 9 Djoussé L, Akinkuolie AO, Wu JH. et al. Fish consumption, omega-3 fatty acids and risk of heart failure: a meta-analysis. Clin Nutr 2012; 31: 846-53
  CrossrefPubMedGoogle Scholar
• 10 Eschen O, Christensen JH, LA Rovere MT. et al. Effects of marine n-3 fatty acids on circulating levels of soluble adhesion molecules in patients with chronic heart failure. Cell Mol Biol (Noisy-le-grand) 2010; 56: 45-51
  PubMedGoogle Scholar
• 11 Finzi AA, Latini R, Barlera S. et al. Effects of n-3 polyunsaturated fatty acids on malignant ventricular arrhythmias in patients with chronic heart failure and implantable cardioverter-defibrillators: A substudy of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Insufficienza Cardiaca (GISSI-HF) trial. Am Heart J 2011; 161: 338-43
  CrossrefPubMedGoogle Scholar
• 12 Harris WS, Gonzales M, Laney N. Effects of Omega-3 Fatty Acids on Heart Rate in Cardiac Transplant Recipients. Am J Cardiol 2006; 98: 1393-5
  CrossrefPubMedGoogle Scholar
• 13 Harris WS, Masson S, Barlera S. et al. Red blood cell oleic acid levels reflect olive oil intake while omega-3 levels reflect fish intake and the use of omega-3 acid ethyl esters: The Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-Heart Failure trial. Nutr Res 2016; 36: 989-94
  CrossrefPubMedGoogle Scholar
• 14 Heydari B, Abdullah S, Pottala JV. et al. Effect of Omega-3 Acid Ethyl Esters on Left Ventricular Remodeling After Acute Myocardial Infarction: The OMEGA-REMODEL Randomized Clinical Trial. Circulation 2016; 134: 378-91
  CrossrefPubMedGoogle Scholar
• 15 Kleber ME, Delgado GE, Lorkowski S. et al. Omega-3 fatty acids and mortality in patients referred for coronary angiography – The Ludwigshafen Risk and Cardiovascular Health Study. Atherosclerosis 2016; 252: 157-81
  PubMedGoogle Scholar
• 16 Köhler A, Bittner D, Löw A. Effects of a convenience drink fortified with n-3 fatty acids on the n-3 index. Br J Nutr 2010; 104: 729-36
  CrossrefPubMedGoogle Scholar
• 17 Kohashi K, Nakagomi A, Saiki Y. et al. Effects of eicosapentaenoic acid on the levels of inflammatory markers, cardiac function and long-term prognosis in chronic heart failure patients with dyslipidemia. J Atheroscler Thromb 2014; 21: 712-29
  CrossrefPubMedGoogle Scholar
• 18 Kojuri J, Ostovan MA, Rezaian GR. et al. Effect of omega-3 on brain natriuretic peptide and echocardiographic findings in heart failure: Double-blind placebo-controlled randomized trial. J Cardiovasc Dis Res 2013; 4: 20-4
  CrossrefPubMedGoogle Scholar
• 19 La Rovere MT, Staszewsky L, Barlera S. et al. GISSI-HF Investigators. n-3PUFA and Holter-derived autonomic variables in patients with heart failure: data from the Gruppo Italiano per lo Studio della Sopravvivenza nell’Insufficienza Cardiaca (GISSI-HF) Holter substudy. Heart Rhythm 2013; 10: 226-32
  CrossrefPubMedGoogle Scholar
• 20 Lukaschek K, von Schacky C, Kruse J. et al. Cognitive impairment is associated with low Omega-3 Index in the elderly. Results from the KORA-Age study. Dementia Geriatr Cogn Dis 2016; 42: 236-45
  PubMedGoogle Scholar
• 21 Marchioli R, Barzi F, Bomba E. et al. GISSI-Prevenzione Investigators. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation 2002; 105: 1897-903
  CrossrefPubMedGoogle Scholar
• 22 Moertl D, Hammer A, Steiner S. et al. Dose-dependent effects of omega-3-polyunsaturated fatty acids on systolic left ventricular function, endothelial function, and markers of inflammation in chronic heart failure of nonischemic origin: a double-blind, placebo-controlled, 3-arm study. Am Heart J 2011; 161 915.e 1-9
  CrossrefPubMedGoogle Scholar
• 23 Mozaffarian D, Lemaitre RN, King IB. et al. Circulating long-chain ω-3 fatty acids and incidence of congestive heart failure in older adults: the cardiovascular health study: a cohort study. Ann Intern Med 2011; 155: 160-70
  CrossrefPubMedGoogle Scholar
• 24 Mozaffarian D, Lemaitre RN, King IB. et al. Plasma phospholipid long-chain ω-3 fatty acids and total and cause-specific mortality in older adults: a cohort study. Ann Intern Med 2013; 158: 515-25
  CrossrefPubMedGoogle Scholar
• 25 Nestel P, Clifton P, Colquhoun D. et al. Indications for Omega-3 Long Chain Polyunsaturated Fatty Acid in the Prevention and Treatment of Cardiovascular Disease. Heart Lung Circ 2015; 24: 769-79
  CrossrefPubMedGoogle Scholar
• 26 Nodari S, Triggiani M, Campia U. et al. Effects of n-3 polyunsaturated fatty acids on left ventricular function and functional capacity in patients with dilated cardiomyopathy. J Am Coll Cardiol 2011; 57: 870-9
  CrossrefPubMedGoogle Scholar
• 27 Ponikowski P, Voors AA, Anker SD. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129-20
  CrossrefPubMedGoogle Scholar
• 28 Ravindran AV, Balneaves LG, Faulkner G. et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments. Can J Psychiatry 2016; 61: 576-87
  CrossrefPubMedGoogle Scholar
• 29 Rice HB, Bernasconi A, Maki KC. et al. Conducting omega-3 clinical trials with cardiovascular outcomes: Proceedings of a workshop held at ISSFAL 2014. Prostaglandins Leukot Essent Fatty Acids 2016; 107: 30-42
  CrossrefPubMedGoogle Scholar
• 30 Sarris J, Murphy J, Mischoulon D. et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry 2016; 173: 575-87
  CrossrefPubMedGoogle Scholar
• 31 Von Schacky C. Omega-3 fatty acids: anti-arrhythmic, pro-arrhythmic, or both?. Frontiers in Cardiac Electrophysiology 2012; 3: 98
  PubMedGoogle Scholar
• 32 Von Schacky C. Der HS-Omega 3 Index^®: klinische Wertigkeit standardisierter Fettsäureanalytik. J Lab Med 2014; 38: 167-78
  PubMedGoogle Scholar
• 33 Von Schacky C. Omega-3 Fatty Acids in Cardiovascular Disease – an Uphill Battle. PLEFA 2015; 92: 41-7
  PubMedGoogle Scholar
• 34 Von Schacky C. ω-3 Fettsäuren und Hirnfunktion. Orthomol Med 2016; 2: 6-10
  PubMedGoogle Scholar
• 35 Siscovick DS, Barringer TA, Fretts AM. et al. Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association. Circulation 2017; 135: e867-e884
  CrossrefPubMedGoogle Scholar
• 36 Tavazzi L, Tognoni G, Franzosi MG. et al. Rationale and design of the GISSI heart failure trial: a large trial to assess the effects of n-3 polyunsaturated fatty acids and rosuvastatin in symptomatic congestive heart failure. Eur J Heart Fail 2004; 6: 635-41
  CrossrefPubMedGoogle Scholar
• 37 Tavazzi L, Maggioni AP, Marchioli R. 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 (9645) 1223-30
  CrossrefPubMedGoogle Scholar
• 38 Wang C, Xiong B, Huang J. The Role of Omega-3 Polyunsaturated Fatty Acids in Heart Failure: A Meta-Analysis of Randomised Controlled Trials. Nutrients. 2016 9. (1)
  PubMedGoogle Scholar
• 39 Wilk JB, Tsai MY, Hanson NQ. et al. Plasma and dietary omega-3 fatty acids, fish intake, and heart failure risk in the Physicians’ Health Study. Am J Clin Nutr 2012; 96: 882-8
  CrossrefPubMedGoogle Scholar
• 40 Wu C, Kato TS, Ji R. et al. Supplementation of l-Alanyl-l-Glutamine and Fish Oil Improves Body Composition and Quality of Life in Patients With Chronic Heart Failure. Circ Heart Fail 2015; 8: 1077-87
  PubMedGoogle Scholar
• 41 Yancy CW, Jessup M, Bozkurt B. et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017 Apr 28
  PubMedGoogle Scholar