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The Value of Omega-3 Fatty Acids in the Prevention of Heart Rhythm Disorders

https://doi.org/10.20996/1819-6446-2020-05-01

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Abstract

One of the trends in modern cardiology is the use of omega-3 polyunsaturated fatty acids (ω-3 PUFA) in the prevention of heart rhythm disorders and the prevention of sudden cardiac death. In experimental studies, it was found that ω-3 PUFAs have a variety of pleiotropic effects: they reduce the formation of oxygen radicals, reduce reperfusion complications, reduce the level of thromboxane and platelet aggregation, and improve endothelial function. The ability of ω-3 PUFA to have an anti-inflammatory effect, which includes the inhibition of leukocyte chemotaxis, the expression of adhesion molecules, the formation of eicosanoids and biologically active substances with powerful anti-inflammatory properties. One of the most significant effects of ω-3 PUFA can be considered their anti-atherogenic effect. Antiarrhythmic properties of го-3 PUFA are associated with the effect on the ion channels of cardiomyocytes, they are able to activate "slow" calcium channels, increase the activity of Ca2+/Mg2+-ATPase and reduce the work of sodium channels. In animal experiments, it has been shown that in conditions of ischemia or adrenergic stimulation, ω-3 PUFA stabilizes the cardiomyocyte membrane, can increase the duration of the effective refractory period, and prevent the development of various heart rhythm disorders. Clinical studies have shown that the administration of ω-3 PUFA in addition to standard treatment reduces the risk of new cases of atrial fibrillation, ventricular arrhythmias and sudden cardiac death.

About the Authors

V. I. Podzolkov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Valery I. Podzolkov - MD, PhD, Professor, Head of Chair of Faculty Therapy №2, Director of the Therapeutic Clinic, University Clinical Hospital №4, Sechenov University.

Trubetskaya ul. 8-2, Moscow, 119991.



A. I. Tarzimanova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Aida I. Tarzimanova - MD, PhD, Professor, Chair of Faculty Therapy №2, Sechenov University.

Trubetskaya ul. 8-2, Moscow, 119991.



References

1. Friberg L. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012;33:1500-10. DOI:10.1093/eurheartj/ehr488.

2. January C.T., Wann L.S., Calkins H., et all. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Heart Rhythm. 2019;16(8):e66-e93. DOI:10.1016/j.hrthm.2019.01.024.

3. Shukla A. Avoiding permanent atrial fibrillation: treatment approaches to prevent disease progression. Vascular Health and Risk Management. 2014;10:1-12. DOI:10.2147/VHRM.S49334.

4. Aviles R.J. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003:108(24):3006-10. DOI:10.1161/01.CIR.0000103131.70301.4F.

5. Asselbergs F.W. C-reactive protein and microalbuminuria are associated with atrial fibrillation. Int J Cardiol. 2005;98(1):73-7. DOI:10.1016/j.ijcard.2003.12.028.

6. Savelieva I. Upstream therapies for management of atrial fibrillation: review of clinical evidence and implications for European Society of Cardiology guidelines. Part I: primary prevention. Europace. 2011;13(3):308-28. DOI:10.1093/europace/eur002.

7. Savelieva I. Statins and polyunsaturated fatty acids for treatment of atrial fibrillation. Nat Clin Pract Car-diovasc Med. 2008;5:30-41. DOI:10.1038/ncpcardio1038.

8. Savelieva I. Primary and secondary prevention of atrial fibrillation with statins and polyunsaturated fatty acids: review of evidence and clinical relevance. Naunyn Schmiedebergs Arch Pharmacol. 2010;381:1-13. DOI:10.1007/s00210-009-0468-y.

9. Sarrazin J.F., Comeau G., Daleau P., et al. Reduced incidence of vagally induced atrial fibrillation and expression levels of connexins by n-3 polyunsaturated fatty acids in dogs. J Am Coll Cardiol. 2007;50(15):1505-12. DOI:10.1016/j.jacc.2007.05.046.

10. Virtanen J., Murus J., Voutilainen S., Tuomainen T. Serum long-chain n-3 polyunsaturated fatty acids and risk of hospital diagnosis of atrial fibrillation in men. Circulation. 2009;120:2315-21. DOI:10.1161/CIRCULATIONAHA.109.852657.

11. Calo L. N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. J Am Coll Cardiol. 2005;45:1723-8. DOI:10.1016/j.jacc.2005.02.079.

12. Skuladottir G.V., Heidarsdottir R., Arnar D.O., et al. Plasma n-3 and n-6 fatty acids and the incidence of atrial fibrillation following coronary artery bypass graft surgery. Eur J Clin Invest. 2011;41:995-1003. DOI:10.1111/j.1365-2362.2011.02497.x.

13. Kumar S., Sutherland F., Lee J.M., et al. Effects of high dose intravenous fish oil on human atrial electrophysiology: implications for possible anti- and pro-arrhythmic mechanisms in atrial fibrillation. Int J Cardiol. 2013;168(3):2754-60. DOI:10.1016/j.ijcard.2013.03.053.

14. Nodari S., Triggiani M., Campia U., et al. n-3 polyunsaturated fatty acids in the prevention of atrial fibrillation recurrences after electrical cardioversion: a prospective, randomized study Circulation. 2011;124(10):1100-6. DOI:10.1161/CIRCULATIONAHA.111.022194.

15. Priori S.G., Blomstrom-Lundqvist C. 2015 European Society of Cardiology Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death summarized by co-chairs. Eur Heart J. 2015;36(41):2757-9. DOI:10.1093/eurheartj/ehv445.

16. Niemeijer M.N., van den Berg M.E., Leening M.J., et al. Declining incidence of sudden cardiac death from 1990 - 2010 in a general middle-aged and elderly population: the Rotterdam Study. Heart Rhythm. 2015;12:123-9. DOI:10.1016/j.hrthm.2014.09.054.

17. Eckart R.E., Shry E.A., Burke A.P., et al. Sudden death in young adults: an autopsy-based series of a population undergoing active surveillance. J Am Coll Cardiol. 2011;58:1254-61. DOI:10.1016/j.jacc.2011.01.049.

18. Vassalini M., Verzeletti A., Restori M., De Ferrari F. An autopsy study of sudden cardiac death in persons aged 1-40 years in Brescia (Italy). J Cardiovasc Med (Hagerstown). 2016;17(6):446-53. DOI:10.2459/JCM.0000000000000234.

19. Mazzanti A., O'Rourke S., Ng K., et al. The usual suspects in sudden cardiac death of the young: a focus on inherited arrhythmogenic diseases. Expert Rev Cardiovasc Ther. 2014;12:499-519. DOI:10.1586/14779072.2014.894884.

20. Wellens H.J., Schwartz P.J., Lindemans F.W., et al. Risk stratification for sudden cardiac death: current status and challenges for the future. Eur Heart J. 2014;35:1642-51. DOI:10.1093/eurheartj/ehu176.

21. Pedersen C.T., Kay G.N., Kalman J., et al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace. 2014;16:1257-83. DOI:10.1093/europace/euu194.

22. De Caterina R. n-3 Fatty acids in cardiovascular disease. N Engl J Med. 2011;364:2439-50. DOI:10.1056/NEJMra1008153.

23. Leaf A., Xiao Y., Kang J., Billman G. Membrane effects of the n-3 fish oil fatty acids, which prevent fatal ventricular arrhythmias. J Membr Biol. 2005;206:129-39. DOI:10.1007/s00232-005-0789-9.

24. Oh D., Talukdar S., Bae, E. et al. GPR120 is an omega-3 fatty acid receptor mediating potent anti-inflammatory and insulin-sensitizing effects. Cell. 2010;142(5):687-98. DOI:10.1016/j.cell.2010.07.041.

25. Calder P. Omega-3 polyunsaturated fatty acids and inflammatory processes: nutrition or pharmacology? Br J Clin Pharmacol. 2013;75(3):645-62. DOI:10.1111/j.1365-2125.2012.04374.x.

26. Cawood A., Ding R., Napper F., et al. Eicosapentaenoic acid (EPA) from highly concentrated n-3 fatty acid ethyl esters is incorporated into advanced atherosclerotic plaques and higher plaque EPA is associated with decreased plaque inflammation and increased stability. Atherosclerosis. 2010;212(1):252-9. DOI:10.1016/j.atherosclerosis.2010.05.022.

27. Leaf A., Kang J.X., Xiao Y.F., Billman G.E. Clinical prevention of sudden cardiac death by omega-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by omega-3 fish oils. Circulation. 2003;107:2646-52. DOI:10.1161/01.CIR.0000069566.78305.33.

28. Leaf A., Xiao Y.F., Kang J.X., Billman G.E. Prevention of sudden cardiac death by omega-3 polyunsaturated fatty acids. Pharmacol Ther. 2003;98:355-77. DOI:10.1016/s0163-7258(03)00039-1.

29. Segal-Isaacson C.J., Wylie-Rosett J. The cardiovascular effects of fish oils and omega-3 fatty acids. Heart Dis. 1999;1:149-54.

30. Von Schacky C. Omega-3 fatty acids and cardiovascular disease. Curr Opin Clin Nutr Metab Care. 2004;7:131-6. DOI:10.1097/00075197-200403000-00005.

31. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis. 2019;290:140-205. DOI:10.1016/j.atherosclerosis.2019. 08.014.

32. Li G., Sun H., Zhang X. et al. Omega-3 polyunsaturated fatty acids inhibit transient outward and ultrarapid delayed rectifier K+ currents and Na+ current in human atrial myocytes. Cardiovasc Res. 2009;81:286-93. DOI:10.1093/cvr/cvn322.

33. Ninio D., Murphy K., Howe P., Saint D. Dietary fish oil protects against stretchinduced vulnerability to atrial fibrillation in a rabbit model. J Cardiovasc Electrophysiol. 2005;16:1189-94. DOI:10.1111/j.1540-8167.2005.50007.x.

34. London B., Albert C., Anderson M.E., et al. Omega-3 fatty acids and cardiac arrhythmias: prior studies and recommendations for future research: a report from the National Heart, Lung, and Blood Institute and Office Of Dietary Supplements Omega-3 Fatty Acids and their Role in Cardiac Arrhythmogenesis Workshop. Circulation. 2007;116:e320-35. DOI:10.1161/CIRCULATIONAHA.107.712984.

35. Bang H.O., Dyerbert J. Lipid metabolism and ischemic heart disease in Greenland Eskimos. In: Draper H, ed. Advances in Nutrition Research. New York, NY: Plenum Press; 1980:1-22.

36. Kagawa Y., Nishizawa M., Suzuki M., et al. Eicosapolyenoic acids of serum lipids of Japanese islanders with low incidence of cardiovascular diseases. J Nutr Sci Vitaminol (Tokyo). 1982;28:441-53. DOI:10.3177/jnsv.28.441.

37. Burr M.L., Fehily A.M., Gilbert J.F., et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet. 1989;2:757-61. DOI:10.1016/s0140-6736(89)90828-3.

38. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial: Gruppo Italiano per lo Studio della Sopravvivenza nell'In-farto miocardico. Lancet. 1999;354:447-55.

39. GISSI-HF investigators. Effect of го-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebocontrolled trial. Lancet. 2008;372:1223-130. DOI:10.1016/S0140-6736(08)61239-8.

40. Poole C., Halcox J., Jenkins-Jones S., et al. Omega-3 fatty acids and mortality outcome in patients with and without type 2 diabetes after myocardial infarction: A retrospective, matched-cohort study. Clin. Ther. 2013;35(1):40-51. DOI:10.1016/j.clinthera.2012.11.008.

41. Bhatt D., Steg P., Miller M. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med. 2019;380:11-22. DOI:10.1056/NEJMoa1812792.

42. Plavinskii S.L., Barinova A.N. Use of Highly Concentrated Polyunsaturated Fatty Acids for Prevention of Complications After Myocardial Infarction. Cost-Utility Analysis. Kardiologiia. 2018;58(2):75-88 (In Russ.) DOI:10.18087/cardio.2018.2.10089.


For citation:


Podzolkov V.I., Tarzimanova A.I. The Value of Omega-3 Fatty Acids in the Prevention of Heart Rhythm Disorders. Rational Pharmacotherapy in Cardiology. 2020;16(3):498-502. (In Russ.) https://doi.org/10.20996/1819-6446-2020-05-01

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