Long-chain n-3 polyunsaturated fatt...

Long-chain n-3 polyunsaturated fatty acids (PUFAs), which are raise only in fish oils, house against cardiovascular disease by several mechanisms, including an anti-inflammatory validity that is thought to stabilize atherosclerotic plaques. In contrast, the n-6 PUFAs rest in vegetable oils could create inflammation and increase plaque instability. Thies and colleagues measured the purports of sunflower and fish oils onward carotid plaque stability in patients scheduled for carotid endarterectomy at an English hospital.

All patients who agreed to participate were randomly assigned to common of three groups, and fasting children samples were drawn for lipid studies. Sixty-one patients took fish oil, 59 took sunflower oil, and 68 took a rule blend of 80:20 palm and soybean oils. Patients maintained their usual diet, monitored their eating with a fodder diary, and took two capsules of oil with each meal, for a total of six capsules (14 g of long-chain PUFAs or command oil) per day. Capsule enumerates and changes in blood lipid on a levels indicated 85 to 90 percent adherence to subject of attention protocols. Patients underwent carotid endarterectomy between seven and 190 days after randomization. A other blood sample was obtained forward the morning of surgery, and the excised plaques were analyzed for fatty-acid composition.

The three disposes of patients were comparable upon entry to the study. The mean age was about 70 years, and the median carotid stenosis was 80 to 95 percent Twenty-six patients withdrew from the contemplation mainly because surgery was performed within seven days or was not undertaken. sum of two units patients withdrew because of symptoms they attributed to the capsules.

Plasma cholesterol on a levels were not affected by treatment with fish or sunflower oil. Plasma triglyceride evens were significantly lowered with fish-oil supplementation, and this benefit increased as treatment continued. The proportions of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the plasma low-density lipoprotein of the same heights increased only in the fish-oil collection Patients in the fish-oil form into groups also had higher proportions of EPAs in their excised carotid plaques. The proportion of EPAs in the plaques correlated with the duration of supplementation. The excised plaques showed significant differences in morphology. Plaques from patients in the fish-oil assemblage were more likely to have thick, fibrous caps, no signs of inflammation, and fewer macrophages. Overall, patients taking fish oil had a greater proportion of image IV lesions (atheromas) and fewer emblem V lesions (fibrotic lesions and fibroatheromas).

The authors judge that dietary supplementation with sunflower oil (36 g of linoleic acid by day) has little effect forward plasma lipid levels and carotid plaque fatty-acid composition and stability. However, fish-oil supplementation lowers triglyceride concentrations and stabilizes carotid atherosclerotic plaques. Increased plaque stability could explain the beneficial consequences such as reduction in unanticipated death. The authors emphasize the potential benefit of fish-oil supplementation in reducing morbidity and mortality from cardiovascular and cerebrovascular disease, including myocardial infarction and stroke

Anne D Walling, MD

Thies F et al. Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controll trial. Lancet February 8 2003; 361:477-85

Editor's Note: This inquiry adds to the impressive evidence showing benefit from fish oils in as well-as; not only-but also; not only-but; not alone-but primary and secondary prevention studies of cardiovascular disease. Should we be urging all patients to eat oily fish at least sum of two units or three times per week? so advice must be provided with great care; frying the fish or serving it with rich sauces and French fries could make health riddles worse. "Oily" fish (e.g., salmon and mackerel) are fit but "greasy" fish (i.e., battered and deep-fried) are bad.--A.D.W.

COPYRIGHT 2003 American Academy of Family Physicians

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