(n-3) fatty acids and cardiovascular health: are effects of EPA and DHA shared or complementary? - PubMed (original) (raw)

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(n-3) fatty acids and cardiovascular health: are effects of EPA and DHA shared or complementary?

Dariush Mozaffarian et al. J Nutr. 2012 Mar.

Abstract

Considerable research supports cardiovascular benefits of consuming omega-3 PUFA, also known as (n-3) PUFA, from fish or fish oil. Whether individual long-chain (n-3) PUFA have shared or complementary effects is not well established. We reviewed evidence for dietary and endogenous sources and cardiovascular effects on biologic pathways, physiologic risk factors, and clinical endpoints of EPA [20:5(n-3)], docosapentaenoic acid [DPA, 22:5(n-3)], and DHA [22:6(n-3)]. DHA requires direct dietary consumption, with little synthesis from or retroconversion to DPA or EPA. Whereas EPA is also largely derived from direct consumption, EPA can also be synthesized in small amounts from plant (n-3) precursors, especially stearidonic acid. In contrast, DPA appears principally derived from endogenous elongation from EPA, and DPA can also undergo retroconversion back to EPA. In experimental and animal models, both EPA and DHA modulate several relevant biologic pathways, with evidence for some differential benefits. In humans, both fatty acids lower TG levels and, based on more limited studies, favorably affect cardiac diastolic filling, arterial compliance, and some metrics of inflammation and oxidative stress. All three (n-3) PUFA reduce ex vivo platelet aggregation and DHA also modestly increases LDL and HDL particle size; the clinical relevance of such findings is uncertain. Combined EPA+DHA or DPA+DHA levels are associated with lower risk of fatal cardiac events and DHA with lower risk of atrial fibrillation, suggesting direct or indirect benefits of DHA for cardiac arrhythmias (although not excluding similar benefits of EPA or DPA). Conversely, EPA and DPA, but not DHA, are associated with lower risk of nonfatal cardiovascular endpoints in some studies, and purified EPA reduced risk of nonfatal coronary syndromes in one large clinical trial. Overall, for many cardiovascular pathways and outcomes, identified studies of individual (n-3) PUFA were relatively limited, especially for DPA. Nonetheless, the present evidence suggests that EPA and DHA have both shared and complementary benefits. Based on current evidence, increasing consumption of either would be advantageous compared to little or no consumption. Focusing on their combined consumption remains most prudent given the potential for complementary effects and the existing more robust literature on cardiovascular benefits of their combined consumption as fish or fish oil for cardiovascular benefits.

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Conflict of interest statement

Author disclosures: D. Mozaffarian reports receiving research grants from GlaxoSmithKline, Sigma Tau, Pronova, and the NIH for an investigator-initiated, not-for-profit clinical trial of fish oil; travel reimbursement, honoraria, or consulting fees from Aramark, Unilever, SPRIM, Nutrition Impact, Bunge, and FoodMinds for topics related to diet and cardiovascular health; and royalties from UpToDate for an online chapter on fish oil. D. Mozaffarian received travel funds and an honorarium from the American Society for Nutrition for giving a presentation and writing a paper for this symposium. J. H. Y. Wu, no conflicts of interest.

Figures

FIGURE 1

FIGURE 1

Major (n-3) PUFA. Major (n-3) PUFA include ALA, EPA, DPA, and docosahexaenoic acid (DHA). ALA is the plant-derived (n-3) PUFA, found in certain seeds, nuts, and their oils. Evidence for its independent cardiovascular effects is still relatively limited. EPA and DHA are the major long-chain (n-3) PUFA derived from seafood consumption. DPA is another long-chain (n-3) PUFA that is contained in smaller amounts in seafood and also synthesized endogenously from EPA. The long hydrocarbon backbones, multiple double bonds, and location of the first double bond in the (n-3) position result in complex and unique 3-dimensional configurations that contribute to the singular biologic properties of these fatty acids. Figure reproduced with permission from (1). ALA, α-linolenic acid; DPA, docosapentaenoic acid.

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