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Improvements reported in patients with chronic HF treated with omega-3 PUFAs
Nodari S. J Am Coll Cardiol. 2011;doi:10.1016/j.jacc.2010.11.017.
Tang WH. J Am Coll Cardiol. 2011;doi:10.1016/j.jacc.2010.11.014.
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Patients with nonischemic dilated cardiomyopathy treated with omega-3 polyunsaturated fatty acids while receiving evidence-based therapy had increases in left ventricular systolic function and functional capacity, as well as reductions in HF hospitalizations, when compared with placebo.
The study included 133 patients (mean age, 63 ± 10 years) with chronic HF due to nonischemic dilated cardiomyopathy and minimal symptoms who were enrolled while taking evidence-based therapy. Researchers prospectively determined LV function and functional capacity at baseline and 12 months after randomization to either 2 g of omega-3 polyunsaturated fatty acids (PUFAs; n=67) or placebo (n=66).
At 12 months, compared with placebo, patients in the omega-3 group had improved LV ejection fraction (15.4%), peak VO2 (10.7%), exercise duration (12.3%) and mean NYHA functional class (omega-3 group decreased from 1.88 ± 0.33 to 1.61 ± 0.49; placebo group increased from 1.83 ± 0.38 to 2.14 ± 0.65). Also reported was an improved HF-related hospitalization rate in the omega-3 group (6% vs. 30%; P=.0002).
“These beneficial effects suggest that omega-3 PUFAs may favorably affect cardiac remodeling and the decline of myocardial function in patients with HF and may account for the reduction in CV hospitalizations and hospitalizations for HF observed in our study,” according to researchers. “However, whether omega-3 PUFAs exert similar effects in patients with HF caused by other etiologies, at more advanced stages or who are not receiving evidence-based therapy remains to be verified.”
Although these results are promising for patients with HF, they highlight a dilemma facing both physicians and guideline committees when viewed with the results of the GISSI-HF trial, W. H. Wilson Tang, MD, and Michael A. Samara, MD, of the Heart and Vascular Institute at the Cleveland Clinic, said in an accompanying editorial.
“Would the benefits be more apparent if omega-3 PUFA supplementation was given at higher doses and at earlier disease stages than that in GISSI-HF,” they wrote. “Without a new clinical trial in sight, we are now challenged to ask ourselves whether we can be convinced to prescribe an otherwise safe and well-tolerated (but not inexpensive) drug to a broad HF population without the traditional strength of endorsement that large scale pivotal studies provide, or whether future clinical effectiveness studies are warranted to justify such indications.”
Cardiology Today’s initial coverage of this study from the Heart Failure Society of America 14th Annual Scientific Meeting can be viewed here.
Disclosures: Dr. Tang has received research support from Abbott Laboratories and is a consultant for Medtronic Inc., and St. Jude Medical. Dr. Samara reported no relevant financial disclosures.
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