In this article we will look at eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the main long-chain polyunsaturated omega-3 fatty acids that have been proposed for their cardiovascular health benefits.
Eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids are the main long-chain polyunsaturated omega-3 fatty acids found in seafood and oily fish and have been suggested for use in the prevention and treatment of cardiovascular disease.
Diet is the main source of these fatty acids, but personal preferences and dietary restrictions, among other factors, can prevent people from consuming sufficient amounts of EPA- and DHA-rich foods, so adequate intake of omega-3 fatty acids is not always achieved.
Therefore, the recommendation to take omega-3 supplements containing EPA and DHA to reduce major cardiovascular disease outcomes is not uncommon, especially for people at high risk for cardiovascular disease or for people with cardiovascular disease who do not consume adequate omega-3 from dietary sources.
Meta-analyses have suggested that adequate supplementation with EPA and DHA may play a role in the prevention of cardiovascular disease and that their protective effect on the prevention of cardiovascular disease and myocardial infarction appears to have a dose-response relationship.
The UK Biobank is a large, prospective cohort study involving around 500,000 participants who were aged 40-69 years at the time of their baseline assessment visit, i.e. between 2006 and 2010.
In a recent study which analysed UK Biobank data, blood levels of DHA were inversely associated with the risk of death from all causes, as well as death from cardiovascular disease, cancer and other causes (EPA levels were not available in this cohort).
This is one of the largest population-based studies examining the relationship between DHA and long-term mortality.
In a secondary analysis, these findings from UK Biobank were merged with those from another recent meta-analysis which included 17 prospective cohort studies examining the associations between DHA and mortality.
The cumulative sample population included 160,404 individuals and 24,342 deaths during an average 14-year follow-up period.
After multivariable adjustment for relevant risk factors, compared with lower, higher levels of DHA were found to be associated with 17% lower risk of all-cause mortality, 21% lower risk of cardiovascular disease mortality, 17% lower risk of cancer mortality, and 15% lower risk of all other forms of mortality.
In this study, the researchers were not able to measure EPA levels or separate the benefits of consumption or blood levels of DHA versus EPA on cardiovascular disease or all-cause mortality.
It has been suggested that EPA may provide greater protection than the combination of EPA and DHA, as previous studies, that used high doses of EPA alone, reported clearly impressive reductions in cardiovascular disease outcomes. However, there are data indicating that there is no clear superiority of EPA versus the combination of EPA and DHA for comparable doses.
It should be noted here that concerns have been raised about the effects of omega-3 fatty acids on increasing the risk of atrial fibrillation, but the increase observed from lower doses (≤1 g/day) is from relatively small to disputed.
Although the dose-response relationship suggests that the effect is real, there is considerable uncertainty about its magnitude. Unfortunately, there are not plenty of data so there is uncertainty in this area.
At present, although there are data suggesting that among patients with atrial fibrillation, higher levels of omega-3 are associated with a lower risk of total and ischaemic stroke, it seems unwise to recommend doses greater than 1 g/day in this population.
In conclusion, we can say that the study that was our focus provides additional evidence on the application of omega-3 fatty acids in a healthy diet in the prevention of cardiovascular disease and other disease outcomes.
These data support the notion that DHA, a marine-derived omega-3 consumed along with EPA, mainly from oily fish or omega-3 supplements, is beneficial for health overall and for cardiovascular health in particular.
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