Heart disease continues to be the taking cause of decease in the United States ; responsible for 26 % of all American deceases in 2006.1 Aspirin is a medicine frequently taken by persons wishing to cut down their hazard for bosom disease. Unfortunately, prolonged acetylsalicylic acid usage has an increased hazard for side effects. A safer replacement for acetylsalicylic acid may be supplementation with omega-3 fatty acids in the signifier of fish oil. Intake of omega-3 fatty acids are proven to cut down inflammatory markers, lower triglycerides, provide minimum decrease in systolic blood force per unit area along with increasing good HDL cholesterin. As omega-3 fatty acids exert cardio-protective effects similar to aspirin while advancing extra cardiovascular benefits with minimum side effects, increasing omega-3 consumption at an early age may diminish the long term hazards associated with cardiovascular disease.
Aspirin was discovered in the mid 1800 ‘s but was non marketed and sold in tablet signifier until 1915. As the first hurting medicine widely distributed, its popularity paved the manner for old ages of future research. Although acetylsalicylic acid was originally marketed for hurting alleviation, it was found that acetylsalicylic acid had a broad scope of effects on the human organic structure. Today acetylsalicylic acid is used to alleviate hurting, lower febrility, lessening redness and inactivate thrombocytes ensuing in decreased curdling. Multiple organisations runing from the American Heart Association to the U.S. Preventative Services Task Force ( USPSTF ) recommend day-to-day acetylsalicylic acids usage by persons deemed to be at high hazard for bosom disease.2,3 Numerous surveies have shown that acetylsalicylic acid can diminish the opportunities of a cardiovascular event. Although day-to-day acetylsalicylic acid usage is deemed cardio-protective, the opportunities of side effects runing from sickness and disquieted tummy to allergic reactions and GI hemorrhage addition with each twelvemonth of uninterrupted usage. The USPSTF recommends that day-to-day acetylsalicylic acids should non be started until age 45 due to the increased hazard of side effects.3 Unfortunately, cardiovascular disease begins in childhood as necropsy consequences have shown grounds of bosom disease in persons every bit immature as 15 old ages old.4 Since bosom disease begins at such an early age, the American Heart Association recommends measuring the cardiovascular hazards for persons get downing at 20 old ages old, along with doing recommendations associating to put on the line alteration.
Omega-3 Fatty Acids
A healthy diet plays an indispensable function in diminishing the opportunities of developing cardiovascular disease. An association with the ingestion of seafood and a reduced hazard of bosom disease was suggested upon finding the composing of nutrients eaten by Eskimos in Greenland in the 1970’s.5,6 Fatty fish contain eicosapentaenoic ( EPA ) and docosahexaenoic ( DHA ) omega-3 fatty acids which provide the cardiovascular protection. EPA and DHA fatty acids can be introduced into the organic structure by eating fatty fish several times per hebdomad or with day-to-day consumption of a fish oil addendum with similar results.7 Flaxseed oil is high in ?-linolenic acid ( ALA ) , a precursor to omega-3 fatty acids. Supplement with flaxseed oil can be used as a vegetable beginning for increasing degrees of omega-3 fatty acids in the blood plasma.8,9 The effectivity of this transition depends on the handiness of the of the enzyme ?-6-desaturase ( Figure 1 ) 10. As ?-6-desaturase has an affinity for linoleic acid ( LA ) , diets high in saturated oils will cut down the likeliness that ALA will be converted into EPA and DHA.11 As EPA is a precursor to DHA, supplementation of EPA merely will besides ensue in increased plasma degrees of DHA. Supplement of DHA merely will ensue in increased plasma degrees of EPA, although the tract for this transition is non to the full understood.11
Prevention of Heart Disease
High LDL cholesterin and triglyceride degrees along with elevated blood force per unit area and increased degrees of inflammatory markers are known to increase the hazard of cardiovascular disease. Primary bar refers to the existent bar of a disease procedure while secondary bar relates to the alteration of hazard factors to minimise the likeliness of disease. Primary bar of cardiovascular disease would include healthy feeding, exercising and turning away of smoke. The add-on of aspirin aids in primary cardiovascular bar by diminishing the inclination of blood to coagulate through thrombocyte inactivation and decrease of redness and the attendant vas harm. Most bosom disease is due to contracting of the arterias through plaque deposition, and the add-on of acetylsalicylic acid may cut down the sum of plaque. A survey by Gurbel et Al. found that the larger the day-to-day dosage of acetylsalicylic acid, the quicker the oncoming of protection.12 Unfortunately every bit many as 35 % of the population may be aspirin immune and are unable to profit from acetylsalicylic acid ‘s cardiovascular protection no affair the dose.12 A recent survey conducted in Turkey found that aspirin opposition increased in people enduring from metabolic syndrome. The prevalence of aspirin opposition was 46.9 per centum in the metabolic syndrome group and merely 20 per centum in the control group.13 It was besides found that the strongest correlativity to aspirin opposition was elevated fasting blood glucose.13 As fasting blood glucose additions, thrombocytes activate due to weave harm from elevated glucose.13 Although supplementation with fish oil has been deemed secondary bar of bosom disease, people that are unable to take acetylsalicylic acids due to immature age, side effects, or aspirin opposition are the most likely to profit from increased omega-3 consumption.
It was late determined that omega-3 fatty exert antiplatelet effects similar to those of aspirin although the exact mechanisms have yet to be determined. While aspirin plants by barricading the production of thromboxane A-2 through suppression of cyclo-oxygenase-1, it is thought that Resolvin E1 ( an EPA derived molecule ) stops platelet collection through interaction with thromboxane receptors.14 By interacting straight with the thromboxane receptors instead than set uping cyclo-oxygenase-1, Resolvin E1 consequences in a similar antiplatelet consequence to aspirin with a reduced hazard of ulcer formation and GI bleeding.14 Another survey found that diets incorporating big sums of DHA decreased the sum of factor VII available for induction of the curdling cascade, farther cut downing the likeliness of clotting.15 It is interesting to observe that omega-3 fatty acids provide an antiplatelet consequence through two distinguishable mechanisms without significantly protracting the hemorrhage clip unlike aspirin.16 In fact, fish oil addendums be given to be good tolerated even at high doses with minimum side effects.
The ratio between omega-6 and omega-3 fatty acids consumed may play a function in the cardio-protective effects of fish oil. Common beginnings of omega-6 fatty acids include vegetable and seed oils along with poulet and eggs. A 3:1 ratio of omega-6 to omega-3 fatty acids provides the best protection against cardiovascular disease.15,17 It is estimated that the mean American diet consequences in an consumption closer to a 10:1 ratio of omega-6 to omega-3 fatty acids.18 As the ratio additions, inflammatory markers are released doing harm to cell walls and stimulate thrombocyte coagulation.17 It was found that supplementation with less than 3 gms of fish oil a twenty-four hours could help in conveying the omega-6 to omega-3 ratio back to the ideal 3:1 ratio.18 EPA delays the ability of neutrophils to migrate across epithelial tissue by changing the needed prostaglandin signal thereby diminishing degranulation and the end point inflammation.19 The neutrophils are non inactivated ; instead a stronger inflammatory signal is required for neutrophil migration across the epithelial tissue to take place.19
Inflammation plays a important function in mending the organic structure after hurt. If the redness becomes chronic, inflammatory chemicals continue to be released which may increase the sum of plaque buildup in the vass near the site of hurt. Once the plaque has begun to develop, continued sums of redness may take to plaque rupture and coagulum formation. Peoples with cardiovascular disease have an elevated C-reactive protein ( CRP ) degree which a normally measured inflammatory marker.17 It has been found that day-to-day acetylsalicylic acids use can restrict the sum of CRP go arounding in the blood.19 Omega-3 fatso acids have non been shown to diminish CRP, although omega-3 fatty acids cut down redness through other mechanisms while supplying plaque stabilization.20 It is suggested that fish oil supplementation may diminish redness by changing the manner the immune cells respond to inflammation.21,22 A survey by Massaro et Al. determined that the presence of DHA decreased the enzymatic activity of COX 2 diminishing the sum of redness present.23
The ideal 3:1 ratio of omega-6 to omega-3 fatty acids aids in ordinance of triglycerides.24 Triglycerides are one of the most common signifier of fat in the human organic structure as they are found in the normal diet and can be synthesized from extra dietetic Calories. Once triglycerides are in the blood watercourse, they circulate until used for energy production or absorbed by adipose tissue for storage. Triglycerides are indispensable for normal cellular operation but lift above recommended degrees increases the hazard of developing bosom disease. The American Heart Association recommends maintaining triglyceride degrees below 150 mg/dL in healthy individuals.25 Consuming 1000 milligram of DHA each twenty-four hours for six hebdomads can ensue in a 21 per centum decrease in triglyceride levels.25 The effectivity of supplementation with omega-3 fatty acids on triglyceride degrees is dose-dependent, as increasing degrees of omega-3 fatty acids are ingested, the lower the triglyceride degrees will fall.24 Interestingly, persons with the highest triglyceride degrees had the greatest response to the fish oil.24 As omega-3 fatty acids provide such a profound triglyceride take downing consequence, pharmaceutical companies have begun marketing prescription medicines with omega-3 fatty acids as the active ingredient.
Changing Cholesterol Profile
Elevated cholesterin is considered a important hazard factor for cardiovascular disease. Low denseness lipoprotein ( LDL ) and high denseness lipoprotein ( HDL ) are the two signifiers of cholesterin normally evaluated in the finding of hazard for cardiovascular disease. It is by and large accepted that low LDL and high HDL degrees cut down the hazard of cardiovascular disease. Omega-3 fatty acids are shown to raise the HDL cholesterin in persons with low HDL degrees by 7.1 percent.26 The consequence on LDL cholesterin has been less marked with a few surveies reasoning that fish oil supplementation may really raise LDL degrees by every bit much as 10 % .27 Direct measuring of blood LDL degrees is hard, hence LDL degrees are calculated utilizing the Friedewald equation. The Friedewald equation is defined as:
LDL Cholesterol = Total Cholesterol – ( HDL Cholesterol + 1/5 Triglycerides )
The Friedewald expression provides an estimation of fasting LDL degrees but becomes less accurate as measured triglyceride degrees increase.28,29 As omega-3 fatty acids have the ability to dramatically lower triglyceride degrees and somewhat increase HDL degrees, measured LDL degrees may falsely look to increase as the initial LDL degrees may hold been calculated inaccurately.26,27,28
Blood Pressure Effectss
High blood pressure or elevated blood force per unit area is a constituent of cardiovascular disease. It is estimated that more than 25 % of the American population presently suffers from high blood pressure. The incidence additions as we age and a huge bulk of the instances have no known cause. Hypertension is a important hazard factor for cardiovascular morbidity and mortality worldwide. Treatment options for high blood pressure include lifestyle alteration and medicine. While lifestyle alteration normally is the initial attack to intervention, medicines should non be withheld indefinitely. Blood force per unit area is recorded as the systolic/diastolic force per unit area. The systolic force per unit area is the maximum sum of force per unit area within the arterias when the bosom is actively undertaking, while the diastolic force per unit area is the force per unit area in the arterias when the bosom is relaxed. The add-on of omega-3 fatty acids has been shown to diminish diastolic blood force per unit area by two – five mmHg.30 It has been suggested that a little addition in blood force per unit area for about 30 proceedingss may happen following consumption of acetylsalicylic acid when taken in the forenoon. One survey really found a 7 mmHg lessening in systolic force per unit area when the acetylsalicylic acid is taken at night.31 Although no clear grounds supports the usage of acetylsalicylic acid for blood force per unit area control, it has been suggested that acetylsalicylic acid should non be used in patients whom high blood pressure is their lone hazard factor due to the increased possibility of hemorrhage.
Surveies have suggested that omega-3 fatty acids have a direct consequence on arrhythmias. Premature ventricular contractions ( PVC ) may be significantly decreased with the add-on of fish oil supplementation by cut downing the irritability of damaged tissue.32 Often tissue that is damaged due to a deficiency of blood flow changes its electrical belongingss ensuing in multiple random electrical signals. It is these random electrical signals that are responsible for a big figure of arrhythmias. Fish oil supplementation has been found to diminish the bosom round by more than 2 beats per minute and may help in the decrease of arrhythmia through decreased O consumption.30,32,33
Both acetylsalicylic acid and fish oil are effectual at take downing the hazards associated with cardiovascular disease. Both fish oil and acetylsalicylic acid work by different mechanisms for their effects. It is suggested that the hazard of shed blooding does non increase when both are taken together.15 Additional research should be conducted to find proper dosing of acetylsalicylic acid and fish oil addendums for the greatest wellness benefits.
As there are multiple ways to integrate omerga-3 fatty acids into one ‘s diet, the determination over which method of supplementation may be hard. While the American Heart Association recommends eating whole fish over fish oil addendums, legion warnings have surfaced over quicksilver and other heavy metal taint of fresh fish.25 Surprisingly, fish oil addendums have been found to be virtually free of heavy metals as the heavy metals have an affinity for proteins and the harvested oil is free of protein.7 As addendum makers are non regulated by the FDA, it is ever possible that contaminates could be introduced in the fabrication procedure. As the addendum companies are responsible for decently labeling their merchandise, it is possible that the listed ingredients may non be right. Fish oil addendums should be made by a respected trade name and the merchandise should bear the USP seal or the GMP cast. The USP seal and the GMP cast signify that the fish oil addendum is labeled suitably and of exceeding quality. These same criterions are followed by pharmaceutical companies to guarantee merchandise safety and efficaciousness.
Normally reported side effects from supplementation with fish oil include a fishy aftertaste, sickness, and diarrhoea. Interestingly, anecdotal studies have stated that maintaining the fish oil capsules in the deep-freeze may cut down the likeliness of side effects. No surveies to day of the month hold looked at whether stop deading the fish oil alters the effectivity of the EPA and DHA fatty acids. It is known that visible radiation and wet can do the oil to go rancid. As the oil becomes rancid, increased Numberss of free groups are developed which may degrade the EPA and DHA and do supplementation less effectual.
As acetylsalicylic acid has been shown to supply cardio-protective effects, yet has a important potency for side effects, accent should be placed on omega-3 fatty acid supplementation prior to age 45. By supplying the ideal 3:1 ratio of omega-6 to omega-3 fatty acids at an early age allows for the potency of detaining aspirin intervention until later in life. As people continue to populate longer, aspirin intervention should be used meagerly for those that will have the greatest benefit while increased fish oil consumption should be recommended prior to cardiovascular disease symptoms are present.