Omega-3 PUFAs improved LV systolic, diastolic function in patients with nonischemic dilated cardiomyopathy

Issue: November 2010

Heart Failure Society of America 14th Annual Scientific Meeting

SAN DIEGO – The addition of omega-3 polyunsaturated fatty acid supplements in patients with nonischemic dilated cardiomyopathy treated with evidence-based therapy led to improved echocardiographic parameters of left ventricular systolic and diastolic function, and functional capacity, according to new trial data. These effects were also associated with a reduction of HF hospitalizations.

This double blind, randomized, placebo-controlled study was designed to test the hypothesis that omega-3 polyunsaturated fatty acids (n-3 PUFAs) improve LV ejection fraction in well-treated patients with stable chronic HF due to a nonischemic dilated cardiomyopathy.

Researchers included patients aged 18 to 75 years who had the following: a diagnosis of nonischemic dilated cardiomyopathy confirmed by coronary angiography, presence of LV defined as an ejection fraction ≤45%, and stable clinical conditions with minimal or no symptoms for at least 3 months and on evidence-based treatment for at least 6 months. Evidence of ischemia that was diagnosed during noninvasive testing, as well as primary valve disease, peripheral arterial disease, atrial fibrillation and the inability to exercise were among the exclusion criteria.

All of the eligible patients (n=133) were randomly assigned to five capsules daily for the first month and two capsules daily for the following 11 months of either n-3 PUFAs (n=67; 850 mg eicosapentaenoic acid, 882 mg docosahexaenoic acid) or an olive oil placebo (n=66). Researchers performed clinical evaluation on a monthly basis.

After 12 months, LVEF increased by 2% in the PUFA group (P<.0001) and decreased 2% in the placebo group (P<.0001). In the PUFA arm, HF hospitalization rate was 6%, whereas it was 30% in the placebo arm (P=.0002). Additionally, all cause hospitalization was roughly 12% lower (P=.0599) and CV hospitalization 27% lower (P=.0029) in the PUFA group.

“Whether n-3 PUFAs exert similar effects in patients with HF due to other etiologies, at more advanced stages, or who are not on evidence-based therapy remains unknown,” said Mihai Gheorghiade, MD, professor, division of cardiology, Northwestern University Feinberg School of Medicine, Chicago, and study researcher, at the end of his presentation. “Further studies are needed to assess the effects of n-3 PUFAs on LV function and on clinical outcomes in selected populations.” – by Brian Ellis

For more information:

Gheorghiade M. LBCT II. Presented at: Heart Failure Society of America 14th Annual Scientific Sessions; Sept. 13-16, 2010; San Diego.

These data coupled with the prior GISSI-HF study suggest that the benefit of omega-3 PUFA in patients with HF may be ‘real’ and, at least in those with [nonischemic dilated cardiomyopathy], may be associated with improved ventricular function. The mechanism may be related to reduced inflammation, although this could be simply a marker.

Given that some experts are already calling for the addition of omega-3 PUFA to the guidelines for HF therapies, a second large randomized controlled trial would seem indicated, including both ischemic and nonischemic patients across a range of clinical severity. It would be desirable in any such trial to include sub-studies dealing with LV functional parameters, exercise capacity and biomarkers to confirm the current findings and potentially extend their applicability.

– Stephen R. Goldsmith, MD
Director, HF Program,Hennepin County Medical Center, Minneapolis

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