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The effects of omega-3 polyunsaturated fatty acids on cardiac rhythm: a critical reassessment.
Pharmacol Ther. 2013 Oct; 140(1):53-80.P&T

Abstract

Although epidemiological studies provide strong evidence for an inverse relationship between omega-3 polyunsaturated fatty acids (n-3 PUFAs) and cardiac mortality, inconsistent and often conflicting results have been obtained from both animal studies and clinical prevention trials. Despite these heterogeneous results, some general conclusions can be drawn from these studies: 1) n-PUFAs have potent effects on ion channels and calcium regulatory proteins that vary depending on the route of administration. Circulating (acute administration) n-3 PUFAs affect ion channels directly while incorporation (long-term supplementation) of these lipids into cell membranes indirectly alter cardiac electrical activity via alteration of membrane properties. 2) n-3 PUFAs reduce baseline HR and increase HRV via alterations in intrinsic pacemaker rate rather than from changes in cardiac autonomic neural regulation. 3) n-3 PUFAs may be only effective if given before electrophysiological or structural remodeling has begun and have no efficacy against atrial fibrillation. 5) Despite initial encouraging results, more recent clinical prevention and animal studies have not only failed to reduce sudden cardiac death but actually increased mortality in angina patients and increased rather than decreased malignant arrhythmias in animal models of regional ischemia. 6) Given the inconsistent benefits reported in clinical and experimental studies and the potential adverse actions on cardiac rhythm noted during myocardial ischemia, n-3 PUFA must be prescribed with caution and generalized recommendations to increase fish intake or to take n-3 PUFA supplements need to be reconsidered.

Authors+Show Affiliations

Department of Physiology and Cell Biology, The Ohio State University, 304 Hamilton Hall, 1645 Neil Ave., Columbus, OH 43210-1218, United States. Electronic address: billman.1@osu.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23735203

Citation

Billman, George E.. "The Effects of Omega-3 Polyunsaturated Fatty Acids On Cardiac Rhythm: a Critical Reassessment." Pharmacology & Therapeutics, vol. 140, no. 1, 2013, pp. 53-80.
Billman GE. The effects of omega-3 polyunsaturated fatty acids on cardiac rhythm: a critical reassessment. Pharmacol Ther. 2013;140(1):53-80.
Billman, G. E. (2013). The effects of omega-3 polyunsaturated fatty acids on cardiac rhythm: a critical reassessment. Pharmacology & Therapeutics, 140(1), 53-80. https://doi.org/10.1016/j.pharmthera.2013.05.011
Billman GE. The Effects of Omega-3 Polyunsaturated Fatty Acids On Cardiac Rhythm: a Critical Reassessment. Pharmacol Ther. 2013;140(1):53-80. PubMed PMID: 23735203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of omega-3 polyunsaturated fatty acids on cardiac rhythm: a critical reassessment. A1 - Billman,George E, Y1 - 2013/06/02/ PY - 2013/05/17/received PY - 2013/05/17/accepted PY - 2013/6/6/entrez PY - 2013/6/6/pubmed PY - 2014/4/8/medline KW - AF KW - AFL KW - ALA KW - APD KW - Atrial fibrillation KW - BP KW - CICR KW - Ca-ATs KW - DADs KW - DHA KW - DPA KW - Docosahexaenoic acid KW - EADs KW - EPA KW - ERP KW - Eicosapentaenoic acid KW - HR KW - HRV KW - Heart rate variability KW - ICDs KW - MI KW - MSNA KW - Omega-3 polyunsaturated fatty acids KW - RBC KW - RYRs KW - SR KW - VF KW - VT KW - Ventricular fibrillation KW - action potential duration KW - alpha-linolenic acid KW - atrial fibrillation KW - atrial flutter KW - blood pressure KW - calcium aftertransients KW - calcium induced calcium release KW - delayed afterdepolarizations KW - docosahexaenoic acid KW - docosapentaenoic acid KW - early afterdepolarizations KW - effective refractory period KW - eicosapentaenoic acid KW - heart rate KW - heart rate variability KW - implantable cardioverter defibrillators KW - muscle sympathetic nerve activity KW - myocardial infarction KW - n−3 PUFAs KW - n−6 PUFAs KW - omega-3 polyunsaturated fatty acids KW - omega-6 polyunsaturated fatty acids KW - red blood cell KW - ryanodine receptors KW - sarcoplasmic reticulum KW - ventricular fibrillation KW - ventricular tachycardia SP - 53 EP - 80 JF - Pharmacology & therapeutics JO - Pharmacol. Ther. VL - 140 IS - 1 N2 - Although epidemiological studies provide strong evidence for an inverse relationship between omega-3 polyunsaturated fatty acids (n-3 PUFAs) and cardiac mortality, inconsistent and often conflicting results have been obtained from both animal studies and clinical prevention trials. Despite these heterogeneous results, some general conclusions can be drawn from these studies: 1) n-PUFAs have potent effects on ion channels and calcium regulatory proteins that vary depending on the route of administration. Circulating (acute administration) n-3 PUFAs affect ion channels directly while incorporation (long-term supplementation) of these lipids into cell membranes indirectly alter cardiac electrical activity via alteration of membrane properties. 2) n-3 PUFAs reduce baseline HR and increase HRV via alterations in intrinsic pacemaker rate rather than from changes in cardiac autonomic neural regulation. 3) n-3 PUFAs may be only effective if given before electrophysiological or structural remodeling has begun and have no efficacy against atrial fibrillation. 5) Despite initial encouraging results, more recent clinical prevention and animal studies have not only failed to reduce sudden cardiac death but actually increased mortality in angina patients and increased rather than decreased malignant arrhythmias in animal models of regional ischemia. 6) Given the inconsistent benefits reported in clinical and experimental studies and the potential adverse actions on cardiac rhythm noted during myocardial ischemia, n-3 PUFA must be prescribed with caution and generalized recommendations to increase fish intake or to take n-3 PUFA supplements need to be reconsidered. SN - 1879-016X UR - https://www.unboundmedicine.com/medline/citation/23735203/The_effects_of_omega_3_polyunsaturated_fatty_acids_on_cardiac_rhythm:_a_critical_reassessment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0163-7258(13)00126-5 DB - PRIME DP - Unbound Medicine ER -