The Clinical Benefit of Omega-3 PUFA Ethyl Esters

Abstract

Chronic heart failure, a syndrome of cardiac dysfunction associated with breathlessness, effort intolerance and fluid retention, affects 1-2% of the population. The most frequent cause is impairment of systolic function of the left ventricle, usually due to coronary artery disease. Hypertension or diabetes often co-exist. Treatment of heart failure (HF) is centred on correction of any reversible pathology and antagonism of the intense neurohormonal activation triggered by the cardiac dysfunction. This is achieved by angiotensin converting enzyme inhibitors (or angiotensin receptor blockers), beta-blockers and in more severe cases, an aldosterone antagonist. The prognosis of HF remains poor – with a first year mortality of over 30%, reducing to 10% per annum thereafter. Death is usually due to either progressive pump failure or sudden death, which is presumably arrhythmic in origin. A randomised double-blind controlled trial of 1g daily of omega-3 polyunsaturated fatty acids (PUFA) ethyl esters in almost 7000 patients with symptomatic chronic heart failure of any cause reported a 9% relative risk reduction in mortality (P=0.04) and 8% relative risk reduction in mortality or cardiovascular hospitalisation (P=0.009)(GISSI-HF). In absolute terms, 56 patients need to be treated for 3.9 years to prevent one death. International guidelines recommend the prescription of 1g daily of n-3 PUFA as an adjuvant to secondary prevention in patients after myocardial infarction (based on the results of GISSI-Prevenzione, published in 1999) and for those with hypertriglyceridaemia, but are likely to be updated to recommend this therapy for patients with heart failure also.