Beyond the Mediterranean Diet: The Role of Omega-3 Fatty Acids in the Prevention of Coronary Heart Disease

Charles R. Harper, MD, Terry A. Jacobson, MD

Disclosures

Prev Cardiol. 2003;6(3) 

In This Article

Implications for Preventive Cardiologists

The available evidence from randomized clinical trials suggests that n-3 PUFAs should have a significant role in the secondary prevention of CHD ( Table II ). Patients with CHD, in particular those at risk for sudden cardiac death (e.g., left ventricular dysfunction, ventricular dysrhythmia, or left ventricular hypertrophy), could initially be advised to increase fish consumption up to one or two servings of fish per week. However, if this was not gastronomically acceptable, one to two fish oil capsules per day (total EPA and DHA of 750-1000 mg) could be an alternative ( Table VII ). In general the complaints of an unpleasant fishy aftertaste are only experienced at higher doses of fish oils such as the doses used to treat severe hypertriglyceridemia. In addition to fish oil, plant-based n-3 PUFA (ALA) can be increased in the diet by using canola or flaxseed oil. Other sources of ALA include vegetables such as purslane and leeks, legumes such as pinto or soybeans, and nuts such as walnuts and butternuts. Consultation with a dietitian may be necessary to ensure that patients are not consuming an excess of calories in an attempt to increase n-3 PUFA levels.

In the primary prevention setting, additional evidence is needed before recommending extensive changes in the diet focusing on increasing n-3 PUFA levels. For now, it seems prudent to encourage patients to consume fish at least twice per week or consider ALA-enriched oils or margarine (flaxseed, canola) as substitutes for existing cooking oils and salad dressings. These changes are consistent with the current NCEP III total lifestyle change diet[46] and the latest revision of the American Heart Association dietary guidelines.[47] Primary prevention trials are needed before recommending large changes in the food supply or the consumption of n-3 supplements. However, if small changes in n-3 consumption can lead to the large CHD event reductions seen in secondary prevention, then the impact on public health could be significant.

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