Current Cardiology Reports

, Volume 6, Issue 5, pp 371–378 | Cite as

Effects of dietary fat intake in sudden death: Reduction of death with omega-3 fatty acids

  • Kaeng W. Lee
  • Ali Hamaad
  • Robert J. MacFadyen
  • Gregory Y. H. Lip


Sudden death is one of the most common modes of death in those who survive a myocardial infarction. A recent study of 11,324 patients showed a marked decrease in risk of sudden cardiac death as well as a reduction in all-cause mortality in the post-myocardial infarction group taking a highly purified form of omega-3 fatty acids, added to the use of other secondary prevention drugs, including à-blockers and lipid-lowering therapy. There is now amounting evidence indicating that the clinical benefits of highly purified omega-3 fatty acids may be attributed to their antiarrhythmogenic properties. Evidence for this mechanism of benefit is reviewed here.


Heart Rate Variability Sudden Cardiac Death Fish Consumption PUFA Supplement Primary Cardiac Arrest 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Myerburg RJ, Interian A Jr, Mitrani RM, et al.: Frequency of sudden cardiac death and profiles of risk. Am J Cardiol 1997, 80:10F-19F.PubMedCrossRefGoogle Scholar
  2. 2.
    Hamaad A, Lip GY, MacFadyen RJ: Unheralded sudden cardiac death: do autonomic tone and thrombosis interact as key factors in aetiology? Ann Med 2003, 35:592–604. Recent comprehensive overview of sudden cardiac deathPubMedCrossRefGoogle Scholar
  3. 3.
    Dyerberg J, Bang HO, Hjorne N: Fatty acid composition of the plasma lipids in Greenland Eskimos. Am J Clin Nutr 1975, 28:958–966.PubMedGoogle Scholar
  4. 4.
    Kromhout D: N-3 fatty acids and coronary heart disease: epidemiology from Eskimos to Western populations. J Intern Med Suppl 1989, 225:47–51.Google Scholar
  5. 5.
    Kromhout D, Bosschieter EB, de Lezenne CC: The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med 1985, 312:1205–1209.PubMedCrossRefGoogle Scholar
  6. 6.
    Dolecek TA: Epidemiological evidence of relationships between dietary polyunsaturated fatty acids and mortality in the multiple risk factor intervention trial. Proc Soc Exp Biol Med 1992, 200:177–182.PubMedGoogle Scholar
  7. 7.
    Rodriguez BL, Sharp DS, Abbott RD, et al.: Fish intake may limit the increase in risk of coronary heart disease morbidity and mortality among heavy smokers. The Honolulu Heart Program. Circulation 1996, 94:952–956.PubMedGoogle Scholar
  8. 8.
    Daviglus ML, Stamler J, Orencia AJ, et al.: Fish consumption and the 30-year risk of fatal myocardial infarction. N Engl J Med 1997, 336:1046–1053.PubMedCrossRefGoogle Scholar
  9. 9.
    Siscovick DS, Raghunathan T, King I, et al.: Dietary intake of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. Am J Clin Nutr 2000, 71:208S-212S.PubMedGoogle Scholar
  10. 10.
    Morris MC, Manson JE, Rosner B, et al.: Fish consumption and cardiovascular disease in the physicians' health study: a prospective study. Am J Epidemiol 1995, 142:166–175.PubMedGoogle Scholar
  11. 11.
    Albert CM, Campos H, Stampfer MJ, et al.: Blood levels of longchain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002, 346:1113–1118.PubMedCrossRefGoogle Scholar
  12. 12.
    Hu FB, Bronner L, Willett WC, et al.: Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 2002, 287:1815–1821.PubMedCrossRefGoogle Scholar
  13. 13.
    Sanderson P, Gill JM, Packard CJ, et al.: UK Food Standards Agency cis-monounsaturated fatty acid workshop report. Br J Nutr 2002, 88:99–104.PubMedCrossRefGoogle Scholar
  14. 14.
    Sanderson P, Finnegan YE, Williams CM, et al.: UK Food Standards Agency alpha-linolenic acid workshop report. Br Nutr 2002, 88:573–579.CrossRefGoogle Scholar
  15. 15.
    Brenna JT: Efficiency of conversion of alpha-linolenic acid to long chain n-3 fatty acids in man. Curr Opin Clin Nutr Metab Care 2002, 5:127–132.PubMedCrossRefGoogle Scholar
  16. 16.
    Hu FB, Stampfer MJ, Manson JE, et al.: Dietary intake of alphalinolenic acid and risk of fatal ischemic heart disease among women. Am J Clin Nutr 1999, 69:890–897.PubMedGoogle Scholar
  17. 17.
    Ascherio A, Rimm EB, Giovannucci EL, et al.: Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. BMJ 1996, 313:84–90.PubMedGoogle Scholar
  18. 18.
    Oomen CM, Ocke MC, Feskens EJ, et al.: Alpha-linolenic acid intake is not beneficially associated with 10-y risk of coronary artery disease incidence: the Zutphen Elderly Study. Am J Clin Nutr 2001, 74:457–463.PubMedGoogle Scholar
  19. 19.
    Burr ML, Fehily AM, Gilbert JF, et al.: Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 1989, 2:757–761.PubMedCrossRefGoogle Scholar
  20. 20.
    Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSIPrevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. Lancet 1999, 354:447–455. Main data paper from the GISS-Prevenzione trial using omega-3 fatty acids for secondary prevention.Google Scholar
  21. 21.
    Marchioli R, Barzi F, Bomba E, et al.: Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation 2002, 105:1897–1903. Time course analysis of protection from omega-3 fatty acids.PubMedCrossRefGoogle Scholar
  22. 22.
    de Lorgeril M, Salen P, Martin JL, et al.: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999, 99:779–785.PubMedGoogle Scholar
  23. 23.
    de Lorgeril M, Salen P, Martin JL, et al.: Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch Intern Med 1998, 158:1181–1187.PubMedCrossRefGoogle Scholar
  24. 24.
    Kang JX, Leaf A: Prevention of fatal cardiac arrhythmias by polyunsaturated fatty acids. Am J Clin Nutr 2000, 71:202S-207S.PubMedGoogle Scholar
  25. 25.
    Billman GE, Kang JX, Leaf A: Prevention of ischemia-induced cardiac sudden death by n-3 polyunsaturated fatty acids in dogs. Lipids 1997, 32:1161–1168.PubMedCrossRefGoogle Scholar
  26. 26.
    Billman GE, Kang JX, Leaf A: Prevention of sudden cardiac death by dietary pure omega-3 polyunsaturated fatty acids in dogs. Circulation 1999, 99:2452–2457.PubMedGoogle Scholar
  27. 27.
    McLennan PL, Abeywardena MY, Charnock JS: Influence of dietary lipids on arrhythmias and infarction after coronary artery ligation in rats. Can J Physiol Pharmacol 1985, 63:1411–1417.PubMedGoogle Scholar
  28. 28.
    McLennan PL, Bridle TM, Abeywardena MY, Charnock JS: Dietary lipid modulation of ventricular fibrillation threshold in the marmoset monkey. Am Heart J 1992, 123:1555–1561.PubMedCrossRefGoogle Scholar
  29. 29.
    McLennan PL: Myocardial membrane fatty acids and the antiarrhythmic actions of dietary fish oil in animal models. Lipids 2001, 36(Suppl):S111-S114.PubMedCrossRefGoogle Scholar
  30. 30.
    Nair SS, Leitch JW, Falconer J, Garg ML: Prevention of cardiac arrhythmia by dietary (n-3) polyunsaturated fatty acids and their mechanism of action. J Nutr 1997, 127:383–393.PubMedGoogle Scholar
  31. 31.
    Pound EM, Kang JX, Leaf A: Partitioning of polyunsaturated fatty acids, which prevent cardiac arrhythmias, into phospholipid cell membranes. J Lipid Res 2001, 42:346–351.PubMedGoogle Scholar
  32. 32.
    Demaison L, Moreau D: Dietary n-3 polyunsaturated fatty acids and coronary heart disease-related mortality: a possible mechanism of action. Cell Mol Life Sci 2002, 59:463–477.PubMedCrossRefGoogle Scholar
  33. 33.
    Goel DP, Maddaford TG, Pierce GN: Effects of omega-3 polyunsaturated fatty acids on cardiac sarcolemmal Na(+)/ H(+) exchange. Am J Physiol Heart Circ Physiol 2002, 283:H1688-H1694.PubMedGoogle Scholar
  34. 34.
    Jouven X, Charles MA, Desnos M, Ducimetiere P: Circulating nonesterified fatty acid level as a predictive risk factor for sudden death in the population. Circulation 2001, 104:756–761.PubMedGoogle Scholar
  35. 35.
    Leaf A: Plasma nonesterified fatty acid concentration as a risk factor for sudden cardiac death: the Paris Prospective Study. Circulation 2001, 104:744–745.PubMedGoogle Scholar
  36. 36.
    Schwartz PJ, Vanoli E, Stramba-Badiale M, et al.: Autonomic mechanisms and sudden death. New insights from analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction. Circulation 1988, 78:969–979.PubMedGoogle Scholar
  37. 37.
    La Rovere MT, Bigger JT Jr, Marcus FI, et al.: Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet 1998, 351:478–484.PubMedCrossRefGoogle Scholar
  38. 38.
    Christensen JH, Christensen MS, Dyerberg J, Schmidt EB: Heart rate variability and fatty acid content of blood cell membranes: a dose-response study with n-3 fatty acids. Am J Clin Nutr 1999, 70:331–337.PubMedGoogle Scholar
  39. 39.
    Christensen JH, Gustenhoff P, Korup E, et al.: Effect of fish oil on heart rate variability in survivors of myocardial infarction: a double blind randomised controlled trial. BMJ 1996, 312:677–678.PubMedGoogle Scholar
  40. 40.
    Christensen JH, Korup E, Aaroe J, et al.: Fish consumption, n-3 fatty acids in cell membranes, and heart rate variability in survivors of myocardial infarction with left ventricular dysfunction. Am J Cardiol 1997, 79:1670–1673.PubMedCrossRefGoogle Scholar
  41. 41.
    Christensen JH, Skou HA, Fog L, et al.: Marine n-3 fatty acids, wine intake, and heart rate variability in patients referred for coronary angiography. Circulation 2001, 103:651–657.PubMedGoogle Scholar
  42. 42.
    Dallongeville J, Yarnell J, Ducimetiere P, et al.: Fish consumption is associated with lower heart rates. Circulation 2003, 108:820–825.PubMedCrossRefGoogle Scholar
  43. 43.
    Brouwer IA, Zock PL, van Amelsvoort LGPM, et al.: Association between n-3 fatty acid status in blood and electrocardiographic predictors of arrhythmia risk in healthy volunteers. Am J Cardiol 2002, 89:629–631.PubMedCrossRefGoogle Scholar
  44. 44.
    McLennan PL, Bridle TM, Abeywardena MY, Charnock JS: Comparative efficacy of n-3 and n-6 polyunsaturated fatty acids in modulating ventricular fibrillation threshold in marmoset monkeys. Am J Clin Nutr 1993, 58:666–669.PubMedGoogle Scholar
  45. 45.
    McLennan PL, Dallimore JA: Dietary canola oil modifies myocardial fatty acids and inhibits cardiac arrhythmias in rats. J Nutr 1995, 125:1003–1009.PubMedGoogle Scholar
  46. 46.
    Pepe S, McLennan PL: Dietary fish oil confers direct antiarrhythmic properties on the myocardium of rats. J Nutr 1996, 126:34–42.PubMedGoogle Scholar
  47. 47.
    Kang JX, Xiao YF, Leaf A: Free, long-chain, polyunsaturated fatty acids reduce membrane electrical excitability in neonatal rat cardiac myocytes. Proc Natl Acad Sci U S A 1995, 92:3997–4001.PubMedCrossRefGoogle Scholar
  48. 48.
    Kang JX, Leaf A: Prevention and termination of beta-adrenergic agonist-induced arrhythmias by free polyunsaturated fatty acids in neonatal rat cardiac myocytes. Biochem Biophys Res Commun 1995, 208:629–636.PubMedCrossRefGoogle Scholar
  49. 49.
    Sellmayer A, Witzgall H, Lorenz RL, Weber PC: Effects of dietary fish oil on ventricular premature complexes. Am J Cardiol 1995, 76:974–977.PubMedCrossRefGoogle Scholar
  50. 50.
    Siscovick DS, Raghunathan TE, King I, et al.: Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995, 274:1363–1367.PubMedCrossRefGoogle Scholar
  51. 51.
    Singh RB, Niaz MA, Sharma JP, et al.: Randomized, doubleblind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival--4. Cardiovasc Drugs Ther 1997, 11:485–491.PubMedCrossRefGoogle Scholar

Copyright information

© Current science inc 2004

Authors and Affiliations

  • Kaeng W. Lee
  • Ali Hamaad
  • Robert J. MacFadyen
  • Gregory Y. H. Lip
    • 1
  1. 1.Haemostasis Thrombosis and Vascular Biology Unit, University Department of MedicineCity HospitalBirminghamEngland

Personalised recommendations