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Omega-3: Fakten
- Therapie und Dosierung
Herzbypass: 4,0g/Tag
EPA & DHA während ca. 1 Jahr nach der Operation
In Fachzeitschriften wurden folgende Artikel über Omega-3
publiziert. Die Liste dieser Publikationen wurde im April 2003
kompiliert und erhebt keinen Anspruch auf Vollständigkeit.
Quelle: MEDLINE.
Die Daten dienen als Referenz für Ärzte und Therapeuten,
damit eine therapeutische Dosis bei Herzbypass festgelegt
werden kann.
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n-3
polyunsaturated fatty acids and cardiovascular diseases.
Nordøy A: Department of Medicine, University of Tromsø,
Norway; Marchioli R, Arnesen H, Videbaek J
Lipids 2001 36 Suppl:S127-9
Abstract
An expert round table discussion on the relationship between intake
of n-3 polyunsaturated fatty acids (PUFA) mainly of marine sources
and coronary heart disease at the 34th
Annual Scientific Meeting of European Society for Clinical Investigation
came to the following conclusions: 1. Consumption of
1-2 fish meals/wk is associated with reduced coronary heart disease
(CHD) mortality. 2. Patients who have experienced myocardial infarction
have decreased risk of total, cardiovascular, coronary, and sudden
death by drug treatment with 1 g/d of ethylesters of n-3 PUFA,
mainly as eicosapentaenoic acid (EPA) and docosahexaenoic acid
(DHA). The effect is present irrespective of high or low traditional
fish intake or simultaneous intake of other drugs for secondary
CHD prevention. n-3 PUFA may also be given as fatty fish or triglyceride
concentrates. 3. Patients who have experienced
coronary artery bypass surgery with venous grafts may reduce graft
occlusion rates by administration of 4 g/d of n-3 PUFA.
4. Patients with moderate hypertension may reduce blood pressure
by administration of 4 g/d of n-3 PUFA. 5. After heart transplantation,
4 g/d of n-3 PUFA may protect against development of hypertension.
6. Patients with dyslipidemia and or postprandial hyperlipemia
may reduce their coronary risk profile by administration of 1-4
g/d of marine n-3 PUFA. The combination with statins seems to
be a potent alternative in these patients. 7. There is growing
evidence that daily intake of up to 1 energy% of nutrients from
plant n-3 PUFA (alpha-linolenic acid) may decrease the risk for
myocardial infarction and death in patients with CHD. This paper
summarizes the conclusions of an expert panel on the relationship
between n-3 PUFA and CHD. The objectives for the experts were
to formulate scientifically sound conclusions on the effects of
fish in the diet and the administration of marine n-3 PUFA, mainly
eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid
(DHA, 22:6n-3), and eventually of plant n-3 PUFA, alpha-linolenic
acid (ALA, 18:3n-3), on primary and secondary prevention of CHD.
Fish in the diet should be considered as part of a healthy diet
low in saturated fats for everybody, whereas additional administration
of n-3 PUFA concentrates could be given to specific groups of
patients. This workshop was organized on the basis of questions
sent to the participants beforehand, on brief introductions by
the participants, and finally on discussion and analysis by a
group of approximately 40 international scientists in the fields
of nutrition, cardiology, epidemiology, lipidology, and thrombosis.
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n-3
fatty acids and revascularization procedures.
Arnesen H: Ullevål University
Hospital, Oslo, Norway
Lipids 2001 36 Suppl:S103-6
Abstract
Largely initiated by studies among Greenland Eskimos
in the early 1970s, great attention has been given to the possible
effects of the very long chain n-3 polyunsaturated fatty acids
(PUFA) in a variety of cardiovascular disease states. A series
of possibly positive effects on pathogenetic mechanisms in cardiovascular
disease has evolved from laboratory studies in cell cultures and
animals as well as in humans, focusing mainly on eicosanoid metabolism
with reduced activities of platelets and leucocytes, reduced plasma
triglycerides and, antiarrhythmic effects in the myocardium. A
rationale for a positive effect of very long chain n-3 PUFA in
the secondary prophylaxis after revascularization procedures obviously
also exists. The positive clinical effects based on prospectively
randomized trials are summarized as follows. After coronary
artery bypass grafting (CABG), the SHOT study showed statistically
significant reduction in angiographic vein graft occlusion in
610 patients after 1 yr with supplementation
of 3.4 g/d of highly concentrated
very long chain n-3 PUFA. The reduction in occlusion rates was
significantly related to the change in the n-3 PUFA concentration
in serum phospholipids during the study period with the occlusion
rate in the upper quartile of such changes at only approximately
50% of that in the lower quartile. These results were also clearly
related to the presence of angina pectoris and occurrence of myocardial
infarction after 1 yr. Several studies were conducted in patients
after percutaneous transluminal coronary angioplasty (PTCA). By
1993, two meta-analyses indicated a positive effect on the restenosis
rate, a significant problem after otherwise successful PTCA. During
the late 1990s, three large prospective randomized placebo-controlled
angiographic studies were conducted with very long n-3 PUFA
5.1-8.0 g/d, all with completely negative results. Today, therefore,
very long chain n-3 PUFA supplementation cannot be recommended
to reduce the incidence of restenosis after PTCA. All studies
were performed without stenting of the coronary lesion. In the
very special revascularization procedure of heart transplantation,
evolving hypertension and accelerated atherosclerosis have been
major clinical problems. In other studies, positive effects by
supplementation with very long chain n-3 PUFA (3.4-5.7
g/d) were obtained on the surrogate end points coronary
vasoreactivity to acetylcholine and hypertension, respectively.
On the basis of the presently available literature from clinical
studies, recommendations for supplementation with very long chain
n-3 PUFA can be given to patients after venous CABG (up to
3.4 g/d), and after heart transplantation (3.4-5.7
g/d) but not to patients after traditional PTCA. In
fact, data from substudies suggested the possibility that large
doses (5.1 g/d) of very long chain n-3 PUFA might be contraindicated
because they induce a proinflammatory state in patients under
oxidative stress.
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Serum
Lp(a) lipoprotein levels in patients with coronary artery disease
and the influence of long-term n-3 fatty acid supplementation.
Eritsland J: Department of Cardiology,
Ullevål Hospital, Oslo, Norway; Arnesen H, Berg K,
Seljeflot I, Abdelnoor M
Scand J Clin Lab Invest 1995 Jul 55:295-300
Abstract
The serum levels of Lp(a) lipoprotein (Lp(a)) were determined
preoperatively in 601 patients with coronary artery disease, undergoing
bypass operations. Compared with a reference group of 99 apparently
healthy individuals, the Lp(a) levels were higher in the patient
group (7.7 mg dl-1 vs. 5.1 mg dl-1, p = 0.012). In the patient
group, there was a weak, but significant negative correlation
between the Lp(a) levels and age (r = -0.10, p = 0.017), and in
both groups the women had higher Lp(a) levels than the men. In
the patients we found no significant correlations between Lp(a)
and other serum lipids or lipoproteins, nor between Lp(a) and
variables in the fibrinolytic system. We investigated the long-term
effects of supplementation with n-3 polyunsaturated fatty acids
(n-3 PUFAs) on the Lp(a) concentrations. Postoperatively, in a
randomized fashion, 280 of the patients received 4 g of an
n-3 PUFA concentrate (containing > 85% of long-chain n-3 PUFAs)
per day, whereas 269 patients comprised the control group.
The fatty acids in serum phospholipids were monitored, and a significant
increase in the phospholipid n-3 fatty acids was noted in the
n-3 PUFA group, as opposed to the virtually unchanged amounts
in the control group. The Lp(a) levels were determined again after
6 months, and, compared with the control group, n-3 PUFA supplementation
had no overall effect on the serum Lp(a) levels.
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Long-term
effects of n-3 fatty acids on serum lipids and glycaemic control.
Eritsland J: Department of Cardiology,
Ullevål Hospital, Oslo, Norway; Seljeflot I, Abdelnoor M,
Arnesen H, Torjesen PA
Scand J Clin Lab Invest 1994 Jul 54:273-80
Abstract
The long-term influence of n-3 polyunsaturated
fatty acids (n-3 PUFAs) on serum lipids and glucose homeostasis
was studied in a group of non-diabetic, moderately hypertriglyceridaemic
patients undergoing coronary artery bypass grafting. They were investigated
according to the same procedure before and 6 months after the
operation. Following randomization postoperatively, 28 patients
received 3.4 g eicosapentaenoic and docosahexaenoic acid per day,
whereas 29 patients comprised the control group. The decline
in serum triglycerides after 6 months was significantly greater
in the n-3 PUFA group than in the control group (median decline,
-33.2% vs. -11.1%, p = 0.002), while no group difference was
noted in serum total, HDL, or LDL cholesterol levels. Fasting plasma
glucose levels decreased less in the n-3 PUFA group compared with
the control group (median change, -0.2 mmol l-1 vs. -0.5 mmol l-1,
p = 0.054). The corresponding changes in fasting insulin levels
were -2 mIU ml-1 in the n-3 PUFA group and no change in the control
group (p = 0.039). In both groups combined, the recorded changes
in serum triglyceride and serum insulin levels were negatively correlated
with the change in serum phospholipid n-3 fatty acids (r = -0.35,
p = 0.008 and r = -0.32, p = 0.016, respectively). An oral glucose
tolerance test revealed no significant group differences after 6
months, neither in the peak levels, nor in the areas under the curves
between 0 and 3h after the glucose load for glucose, insulin, and
C-peptide. |
Influence
of a concentrated ethylester compound of n-3 fatty acids on lipids,
platelets and coagulation in patients undergoing coronary bypass
surgery.
Nilsen DW: Dept. of Medicine, University of Tromsø, Norway;
Dalaker K, Nordøy A, Osterud B, Ingebretsen OC, Lyngmo V,
Almdahl S, Vaage J, Rasmussen K
Thromb Haemost 1991 Aug 66:195-201
Abstract
Twenty patients accepted for coronary bypass surgery were
randomized to receive either a concentrated ethylester compound
of n-3 fatty acids, with a daily dose of 3.15 g of eicosapentaenoic
acid (EPA) and 1.89 g of docosahexaenoic acid (DHA), or corn
oil (controls) in a double blind study, to evaluate the effect on
lipids, platelets and coagulation during the pre- and postoperative
phase. Only patients with fasting triglyceride (TG) levels greater
than or equal to 1.6 mmol/l at recruitment were eligible. The study
was continued for 5 to 6 months. Surgery was usually performed
at mid-intervention. Blood samples were collected during morning
hours in fasting subjects, just prior to intervention, preoperatively
and at final postoperative follow-up. Moreover, blood loss was accurately
accounted for postoperatively. A threefold increase (p = 0.0001)
of EPA was noted at pre- and postoperative follow-up. TG-levels
were reduced 20 and 39%, respectively, in patients on n-3 fatty
acids, reaching statistical significance at end of intervention
(p = 0.034). TG-levels in controls remained largely unchanged.
In patients on n-3 fatty acids, there was a statistically significant
increase in serum total cholesterol preoperatively, but this change
was no longer present at completion of the study. No significant
changes were noted in platelet function, as judged by bleeding time,
collagen induced platelet aggregation and release of TxB2 during
aggregation. Parameters of extrinsic coagulation, including phospholipase
C-sensitive factor VII (PLC-VII) and extrinsic pathway inhibitor
(EPI), also remained essentially unchanged in both groups of patients.
However, fibrinogen was significantly reduced in controls (p less
than 0.05) at end of intervention. |
Thromboplastin
activities and monocytes in the coronary circulation of reperfused
human myocardium. No effect of preoperative treatment with n-3 fatty
acids.
Almdahl SM: Department of Surgery, University of Tromsø,
Norway; Nilsen DW, Osterud B, Sørlie DG, Vaage J
Scand J Thorac Cardiovasc Surg 1993 27:81-6
Abstract
In a double-blind study 18 patients were randomized to receive a
daily dietary supplement of concentrated ethyl ester compound of
n-3 fatty acids or placebo (corn oil) for at least 6 weeks before
coronary bypass surgery. Three-fold increase of serum eicosapentaenoic
acid and 20% reduction of triglyceride levels were found preoperatively
in the n-3 group, while the two groups were similar as regards monocyte
and platelet counts, mean platelet volume and monocyte activation
as expressed by thromboplastin activities. For determination of
transcardiac gradients, coronary sinus and aortic blood were sampled
preoperatively 5, 10 and 30 minutes after release of the aortic
cross-clamp. In both patient groups the monocyte count was lower
in coronary sinus than in aortic blood at 5 and 10 minutes, but
the differences were not significant. The platelet counts showed
no significant change. In vitro stimulation of monocytes, however,
evoked significantly (p < 0.05) less thromboplastin activity
in coronary sinus blood than in aortic blood at all three sampling
times, without significant intergroup difference. The monocytes
most sensitive to activation presumably were trapped in the reperfused
myocardium, and this sequestration was not hindered by pretreatment
with n-3 fatty acids. |
Long-term
metabolic effects of n-3 polyunsaturated fatty acids in patients
with coronary artery disease.
Eritsland J: Department of Cardiology, Ullevål University
Hospital, Oslo, Norway; Arnesen H, Seljeflot I, Høstmark
AT
Am J Clin Nutr 1995 Apr 61:831-6
Abstract
The long-term metabolic effects of n-3 fatty acids were studied
in patients with coronary artery disease. They were investigated
before and 9 mo after bypass surgery. After postoperative
randomization, 260 patients received 4 g fish-oil concentrate/d
(approximately 3.4 g eicosapentaenoic and docosahexaenoic acids/d),
whereas 251 patients comprised the control group. No group differences
in the intake of energy and nutrients, apart from n-3 fatty acids,
were discerned from dietary records. Compliance was affirmed by
analyses of serum phospholipid fatty acids. Serum triglyceride
concentrations were lowered by 19.1% in the fish-oil group,
but no influence on the concentrations of cholesterol or apolipoproteins
A-I and B-100 was seen. The concentrations of plasma glucose and
serum insulin and C-peptide were not influenced by fish oil. The
activity of liver enzymes increased slightly, but significantly,
in the fish-oil group, whereas no group difference in the serum
concentrations of thiobarbituric acid-reactive substances was observed.
Thus, no adverse metabolic effects of long-term fish-oil supplementation
assumed to be of clinical importance were seen. |
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