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Erschienen in: Current Atherosclerosis Reports 3/2021

01.03.2021 | Statin Drugs (R. Ceska, Section Editor)

The Truth About Fish (Oil) in the Treatment of Dyslipidemia

verfasst von: Jan Pitha, Rudolf Poledne

Erschienen in: Current Atherosclerosis Reports | Ausgabe 3/2021

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Abstract

Purpose of Review

To discuss the effect of fish oils on dyslipidemias and associated disorders.

Recent Findings

The most important lipid effect of fish oils is reducing plasma triglycerides and the main potential protection against cardiovascular events is very probably mediated also through other mechanisms including anti-inflammatory ones. The best results are available for omega-3 fatty acids, namely, eicosapentaenoic acid. Less evidence is available for the impact of ω-3 fatty acids on liver steatosis/steatohepatitis and acute pancreatitis. In addition, particular fish oils have variable content of saturated and unsaturated fatty acids with different anti- or pro-oxidative potential, and the suboptimal ratio of these compounds could attenuate or abolish their beneficial properties.

Summary

Fish products with optimal proportion of fatty acids, particularly high content of eicosapentaenoic acid, could be recommended to patients with dyslipidemias, especially to those at high risk for cardiovascular disease; less evidence is available for liver disease and acute pancreatitis.
Literatur
2.
Zurück zum Zitat Langlois MR, Chapman MJ, Cobbaert C, Mora S, Remaley AT, Ros E, et al. European atherosclerosis society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) joint consensus initiative. Quantifying Atherogenic lipoproteins: current and future challenges in the era of personalized medicine and very low concentrations of LDL cholesterol. A consensus Statement from EAS and EFLM. Clin Chem. 2018;64(7):1006–33. https://doi.org/10.1373/clinchem.2018.287037.CrossRefPubMed Langlois MR, Chapman MJ, Cobbaert C, Mora S, Remaley AT, Ros E, et al. European atherosclerosis society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) joint consensus initiative. Quantifying Atherogenic lipoproteins: current and future challenges in the era of personalized medicine and very low concentrations of LDL cholesterol. A consensus Statement from EAS and EFLM. Clin Chem. 2018;64(7):1006–33. https://​doi.​org/​10.​1373/​clinchem.​2018.​287037.CrossRefPubMed
4.
Zurück zum Zitat Authors/Task Force Members; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis 2019: 290:140–205. https://doi.org/10.1016/j.atherosclerosis.2019.08.014. Erratum in: Atherosclerosis. 2020 Feb;294:80–82. Authors/Task Force Members; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis 2019: 290:140–205. https://​doi.​org/​10.​1016/​j.​atherosclerosis.​2019.​08.​014. Erratum in: Atherosclerosis. 2020 Feb;294:80–82.
5.
Zurück zum Zitat •• Preston Mason R. New insights into mechanisms of action for omega-3 fatty acids in atherothrombotic cardiovascular disease. Curr Atheroscler Rep. 2019;21(1):2. https://doi.org/10.1007/s11883-019-0762-1Comprehensive but wide range summary focused on several effects of omega-3 fatty acids beyond lipid effects and stressing specific effects of eicosapentaenoic acid literally on molecular/cell membrane level.CrossRefPubMedPubMedCentral •• Preston Mason R. New insights into mechanisms of action for omega-3 fatty acids in atherothrombotic cardiovascular disease. Curr Atheroscler Rep. 2019;21(1):2. https://​doi.​org/​10.​1007/​s11883-019-0762-1Comprehensive but wide range summary focused on several effects of omega-3 fatty acids beyond lipid effects and stressing specific effects of eicosapentaenoic acid literally on molecular/cell membrane level.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Rimm EB, Appel LJ, Chiuve SE, Djoussé L, Engler MB, Kris-Etherton PM, et al. American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease: a science advisory from the American Heart Association. Circulation. 2018;138(1):e35–47. https://doi.org/10.1161/CIR.0000000000000574.CrossRefPubMedPubMedCentral Rimm EB, Appel LJ, Chiuve SE, Djoussé L, Engler MB, Kris-Etherton PM, et al. American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease: a science advisory from the American Heart Association. Circulation. 2018;138(1):e35–47. https://​doi.​org/​10.​1161/​CIR.​0000000000000574​.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat •• Sherratt, Samuel CR, Lero M, Mason RP. Are dietary fish oil supplements appropriate for dyslipidemia management? A review of the evidence. Curr Opin Lipidol. 2020;31(2):94–100. https://doi.org/10.1097/MOL.0000000000000665Correctly and critically written review focused on the drawbacks of fish oils regarding their content and ensuing differences in biological effets, which could be even harmful. •• Sherratt, Samuel CR, Lero M, Mason RP. Are dietary fish oil supplements appropriate for dyslipidemia management? A review of the evidence. Curr Opin Lipidol. 2020;31(2):94–100. https://​doi.​org/​10.​1097/​MOL.​0000000000000665​Correctly and critically written review focused on the drawbacks of fish oils regarding their content and ensuing differences in biological effets, which could be even harmful.
11.
Zurück zum Zitat • Amigó N, Akinkuolie AO, Chiuve SE, Correig X, Cook NR, Mora S. Habitual fish consumption, ω-3 fatty acids, and nuclear magnetic resonance lipoprotein subfractions in women. J Am Heart Assoc. 2020;9(5):e014963. https://doi.org/10.1161/JAHA.119.014963.Studyof the association between consumption of fish and ω-3 fatty acids with complex lipoproteins measurements including nuclear magnetic resonance spectroscopy in 26 000 women. Differences observed for high intake of eicosapentaenoic acid versus docosahexaenoic acid and alfa-linolenic acid.CrossRefPubMedPubMedCentral • Amigó N, Akinkuolie AO, Chiuve SE, Correig X, Cook NR, Mora S. Habitual fish consumption, ω-3 fatty acids, and nuclear magnetic resonance lipoprotein subfractions in women. J Am Heart Assoc. 2020;9(5):e014963. https://​doi.​org/​10.​1161/​JAHA.​119.​014963.​Studyof the association between consumption of fish and ω-3 fatty acids with complex lipoproteins measurements including nuclear magnetic resonance spectroscopy in 26 000 women. Differences observed for high intake of eicosapentaenoic acid versus docosahexaenoic acid and alfa-linolenic acid.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Harris WS, Connor WE, Alam N, Illingworth DR. Reduction of postprandial triglyceridemia in humans by dietary n-3 fatty acids. J Lipid Res. 1988;29(11):1451–60.CrossRef Harris WS, Connor WE, Alam N, Illingworth DR. Reduction of postprandial triglyceridemia in humans by dietary n-3 fatty acids. J Lipid Res. 1988;29(11):1451–60.CrossRef
20.
Zurück zum Zitat • Mason RP, Sherratt SC, Jacob RF. Eicosapentaenoic acid inhibits oxidation of ApoB-containing lipoprotein particles of different size in vitro when administered alone or in combination with atorvastatin active metabolite compared with other triglyceride-lowering agents. J Cardiovasc Pharmacol 2016: 68:33–40. https://doi.org/10.1097/FJC.0000000000000379 95. Inhibition of oxidative processes by EPA was described only with metabolite of atorvastatin but not with fibrates, niacin and vitamin E. • Mason RP, Sherratt SC, Jacob RF. Eicosapentaenoic acid inhibits oxidation of ApoB-containing lipoprotein particles of different size in vitro when administered alone or in combination with atorvastatin active metabolite compared with other triglyceride-lowering agents. J Cardiovasc Pharmacol 2016: 68:33–40. https://​doi.​org/​10.​1097/​FJC.​0000000000000379​ 95. Inhibition of oxidative processes by EPA was described only with metabolite of atorvastatin but not with fibrates, niacin and vitamin E.
22.
Zurück zum Zitat •• Mason RP, Libby P, Bhatt DL. Emerging mechanisms of cardiovascular protection for the omega-3 fatty acid eicosapentaenoic acid. Arterioscler Thromb Vasc Biol. 2020;40(5):1135–47. https://doi.org/10.1161/ATVBAHA.119.313286Review focused on proved but mainly newly discussed mechanisms of the effects of omega-3 fatty acids including cell membrane composition. In addition, it is also proposing potential future directions of research.CrossRefPubMedPubMedCentral •• Mason RP, Libby P, Bhatt DL. Emerging mechanisms of cardiovascular protection for the omega-3 fatty acid eicosapentaenoic acid. Arterioscler Thromb Vasc Biol. 2020;40(5):1135–47. https://​doi.​org/​10.​1161/​ATVBAHA.​119.​313286Review focused on proved but mainly newly discussed mechanisms of the effects of omega-3 fatty acids including cell membrane composition. In addition, it is also proposing potential future directions of research.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Stansby ME. Nutritional properties of fish oils. World Rev Nutr Diet. 1969;11:46–105.CrossRef Stansby ME. Nutritional properties of fish oils. World Rev Nutr Diet. 1969;11:46–105.CrossRef
28.
Zurück zum Zitat • Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. REDUCE-IT Investigators. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 2019:380(1):11–22. https://doi.org/10.1056/NEJMoa1812792. Already well known study proving significant effect of eicosapentaenoic acid on clinical events - randomized, placebo control trial - the best recently available evidence. • Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. REDUCE-IT Investigators. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 2019:380(1):11–22. https://​doi.​org/​10.​1056/​NEJMoa1812792. Already well known study proving significant effect of eicosapentaenoic acid on clinical events - randomized, placebo control trial - the best recently available evidence.
29.
Zurück zum Zitat •• Budoff MJ, Bhatt DL, Kinninger A, Lakshmanan S, Muhlestein JB, Le VT, et al. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J. 2020:ehaa652. https://doi.org/10.1093/eurheartj/ehaa652Randomized placebo controlled trial focused on regression of atherosclerosis which was observed at treatment identical to REDUCE-IT trial - supportive and mechanistic parallel study. •• Budoff MJ, Bhatt DL, Kinninger A, Lakshmanan S, Muhlestein JB, Le VT, et al. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J. 2020:ehaa652. https://​doi.​org/​10.​1093/​eurheartj/​ehaa652Randomized placebo controlled trial focused on regression of atherosclerosis which was observed at treatment identical to REDUCE-IT trial - supportive and mechanistic parallel study.
31.
Zurück zum Zitat Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, et al. Japan EPA lipid intervention study (JELIS) Investigators. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369(9567):1090–8. https://doi.org/10.1016/S0140-6736(07)60527-3 Erratum in: Lancet 2007: 370(9583):220.CrossRefPubMed Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, et al. Japan EPA lipid intervention study (JELIS) Investigators. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369(9567):1090–8. https://​doi.​org/​10.​1016/​S0140-6736(07)60527-3 Erratum in: Lancet 2007: 370(9583):220.CrossRefPubMed
32.
Zurück zum Zitat • ASCEND Study Collaborative Group, Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, et al. Effects of n-3 fatty acid supplements in diabetes mellitus. N Engl J Med. 2018;379(16):1540–50. https://doi.org/10.1056/NEJMoa1804989Clinical trial using lower dose of omega-3 fatty acids (1 g/day) with negative results.CrossRef • ASCEND Study Collaborative Group, Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, et al. Effects of n-3 fatty acid supplements in diabetes mellitus. N Engl J Med. 2018;379(16):1540–50. https://​doi.​org/​10.​1056/​NEJMoa1804989Clinical trial using lower dose of omega-3 fatty acids (1 g/day) with negative results.CrossRef
33.
Zurück zum Zitat • Nicholls SJ, Lincoff AM, Bash D, Ballantyne CM, Barter PJ, Davidson MH, et al. Assessment of omega-3 carboxylic acids in statin-treated patients with high levels of triglycerides and low levels of high-density lipoprotein cholesterol: rationale and design of the STRENGTH trial. Clin Cardiol. 2018;41:1281–8. https://doi.org/10.1002/clc.23055Clinical trial using mixutre of omega-3 fatty acids (eicosapentaenoic and docosahexaenoic acid) terminated for futility.CrossRefPubMedPubMedCentral • Nicholls SJ, Lincoff AM, Bash D, Ballantyne CM, Barter PJ, Davidson MH, et al. Assessment of omega-3 carboxylic acids in statin-treated patients with high levels of triglycerides and low levels of high-density lipoprotein cholesterol: rationale and design of the STRENGTH trial. Clin Cardiol. 2018;41:1281–8. https://​doi.​org/​10.​1002/​clc.​23055Clinical trial using mixutre of omega-3 fatty acids (eicosapentaenoic and docosahexaenoic acid) terminated for futility.CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Havel RJ. Pathogenesis, differentiation and management of hypertriglyceridemia. Adv Intern Med. 1969;15:117–54.PubMed Havel RJ. Pathogenesis, differentiation and management of hypertriglyceridemia. Adv Intern Med. 1969;15:117–54.PubMed
Metadaten
Titel
The Truth About Fish (Oil) in the Treatment of Dyslipidemia
verfasst von
Jan Pitha
Rudolf Poledne
Publikationsdatum
01.03.2021
Verlag
Springer US
Erschienen in
Current Atherosclerosis Reports / Ausgabe 3/2021
Print ISSN: 1523-3804
Elektronische ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-021-00904-9

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