Skip to main content
Log in

Plasma Omega-3 Polyunsaturated Fatty Acids and Survival in Patients with Chronic Heart Failure and Major Depressive Disorder

  • Published:
Journal of Cardiovascular Translational Research Aims and scope Submit manuscript

Abstract

The omega-3 fatty acid (FA) concentration is low in patients with coronary heart disease (CHD). Supplement of omega-3 FA improves cardiovascular outcomes in patients with CHD and heart failure (HF). However, plasma omega-3 FA and its role for prognosis in HF patients have not been examined previously. In this study, we explore the prognostic value of omega-3 polyunsaturated FA in HF patients with major depressive disorder (MDD). Plasma was obtained from HF patients with MDD who participated in the Sertraline Against Depression and Heart Disease in Chronic Heart Failure trial. FA methyl esters were analyzed by the method of a flame ionization detector. Weight percent is the unit of the omega compounds. The primary outcome was survival which was analyzed using Cox proportional hazards regression modeling. A total of 109 depressed HF patients had adequate volume for completion of the FA assays. Plasma total omega-3 (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.43–0.98) and EPA_0.1 unit (HR 0.73, 95% CI 0.56–0.96) were significantly associated with survival of patients with HF and co-morbid MDD. The results suggest that low plasma omega-3 FA is a significant factor for reduced survival in HF patients with MDD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Albert, C. M., Hennekens, C. H., O'Donnell, C. J., et al. (1998). Fish consumption and risk of sudden cardiac death. Journal of the American Medical Association, 279(1), 23–28.

    Article  PubMed  CAS  Google Scholar 

  2. Kromhout, D., Bosschieter, E. B., & Coulander, C. D. (1985). The inverse relation between fish consumption and 20-year mortality from coronary heart disease. New England Journal of Medicine, 312(19), 1205–1209.

    Article  PubMed  CAS  Google Scholar 

  3. Lavie, C. J., & Milani, R. V. (1996). Fish oils. In F. H. Messerli (Ed.), Cardiovascular drug therapy (pp. 1608–1613). Philadelphia: Saunders.

    Google Scholar 

  4. Lee, J. H., O'Keefe, J. H., Lavie, C. J., Marchioli, R., & Harris, W. S. (2008). Omega-3 fatty acids for cardioprotection. Mayo Clinic Proceedings, 83(3), 324–332.

    Article  PubMed  CAS  Google Scholar 

  5. Yokoyama, M., Origasa, H., Matsuzaki, M., et al. (2007). Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): A randomised openlabel, blinded endpoint analysis. Lancet, 369(9567), 1090–1098.

    Article  PubMed  CAS  Google Scholar 

  6. Valagussa, F., Franzosi, M. G., Geraci, E., et al. (1999). Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: Results of the GISSI-Prevenzione trial. Lancet, 354(9177), 447–455.

    Article  CAS  Google Scholar 

  7. Harris, W. S., Mozaffarian, D., Rimm, E., et al. (2009). Omega-6 fatty acids and risk for cardiovascular disease a science advisory from the American Heart Association Nutrition Subcommittee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention. Circulation, 119(6), 902–907. doi:10.1161/circulationaha.108.191627.

    Article  PubMed  Google Scholar 

  8. Kris-Etherton, P. M., Harris, W. S., Appel, L. J., & Nutr, C. (2003). Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Arteriosclerosis Thrombosis and Vascular Biology, 23(2), E20–E31. doi:10.1161/01.atv.0000038493.65177.94.

    Article  CAS  Google Scholar 

  9. Lichtenstein, A. H., Appel, L. J., Brands, M., et al. (2006). Diet and lifestyle recommendations revision 2006—A scientific statement from the American Heart Association Nutrition Committee. Circulation, 114(1), 82. doi:10.1161/circulationaha.106.176158.

    Article  PubMed  Google Scholar 

  10. Tavazzi, L., Maggioni, A. P., Marchioli, R., et al. (2008). Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): A randomised, double-blind, placebo-controlled trial. Lancet, 372(9645), 1223–1230. doi:10.1016/s0140-6736(08)61239-8.

    Article  PubMed  Google Scholar 

  11. Jiang, W., O'Connor, C., Silva, S. G., et al. (2008). Safety and efficacy of sertraline for depression in patients with CHF (SADHART-CHF): A randomized, double-blind, placebo-controlled trial of sertraline for major depression with congestive heart failure. American Heart Journal, 156(3), 437–444. doi:10.1016/j.ahj.2008.05.003.

    Article  PubMed  CAS  Google Scholar 

  12. O'Connor, C. M., Jiang, W., Kuchibhatla, M., et al. (2010). Safety and efficacy of sertraline for depression in patients with heart failure: Results of the SADHART-CHF trial. Journal of the American College of Cardiology, 56(9), 692–699.

    Article  PubMed  Google Scholar 

  13. Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597.

    Article  PubMed  CAS  Google Scholar 

  14. Bailey-Hall, E., Nelson, E. B., & Ryan, A. S. (2008). Validation of a rapid measure of blood PUFA levels in humans. Lipids, 43(2), 181–186. doi:10.1007/s11745-007-3140-7.

    Article  PubMed  CAS  Google Scholar 

  15. Lands, W. E. M. (2003). Functional foods in primary prevention or nutraceuticals in secondary prevention? Current Topics in Nutraceutical Research, 1, 113–119.

    CAS  Google Scholar 

  16. Paganelli, F., Maixent, J. M., Duran, M. J., Parhizgar, R., Pieroni, G., & Sennoune, S. (2001). Altered erythrocyte n-3 fatty acids in Mediterranean patients with coronary artery disease. Int J Cardiol, 78(1), 27–32.

    Article  PubMed  CAS  Google Scholar 

  17. Rissanen, T., Voutilainen, S., Nyyssonen, K., Lakka, T. A., & Salonen, J. T. (2000). Fish oil-derived fatty acids, docosahexaenoic acid and docosapentaenoic acid, and the risk of acute coronary events—the Kuopio Ischaemic Heart Disease Risk Factor Study. Circulation, 102(22), 2677–2679.

    PubMed  CAS  Google Scholar 

  18. Rupp, H., Wagner, D., Rupp, T., Schulte, L. M., & Maisch, B. (2004). Risk stratification by the “EPA + DHA level” and the “EPA/AA ratio”—Focus on anti-inflammatory and antiarrhythmogenic effects of long-chain omega-3 fatty acids. Herz, 29(7), 673–685. doi:10.1007/s00059-004-2602-4.

    Article  PubMed  Google Scholar 

  19. Siscovick, D. S., Raghunathan, T. E., King, I., et al. (1995). Dietary-intake and cell-membrane levels of long-chain n-3 polyunsaturated fatty-acids and the risk of primary cardiac-arrest. JAMA: The Journal of the American Medical Association, 274(17), 1363–1367.

    Article  CAS  Google Scholar 

  20. Harris, W. S., Poston, W. C., & Haddock, C. K. (2007). Tissue n-3 and n-6 fatty acids and risk for coronary heart disease events. Atherosclerosis, 193(1), 1–10. doi:10.1016/j.atherosclerosis.2007.03.018.

    Article  PubMed  CAS  Google Scholar 

  21. Mori, T. A., & Woodman, R. J. (2006). The independent effects of eicosapentaenoic acid and docosahexaenoic acid on cardiovascular risk factors in humans. Current Opinion in Clinical Nutrition and Metabolic Care, 9(2), 95–104.

    Article  PubMed  CAS  Google Scholar 

  22. Wilhelm, M., Tobias, R., Asskali, F., et al. (2008). Red blood cell omega-3 fatty acids and the risk of ventricular arrhythmias in patients with heart failure. American Heart Journal, 155(6), 971–977. doi:10.1016/j.ahj.2007.11.045.

    Article  PubMed  CAS  Google Scholar 

  23. Frasure-Smith, N., Lesperance, F., & Julien, P. (2004). Major depression is associated with lower omega-3 fatty acid levels in patients with recent acute coronary syndromes. Biological Psychiatry, 55(9), 891–896. doi:10.1016/j.biopsych.2004.01.021S0006322304001076.

    Article  PubMed  CAS  Google Scholar 

  24. Peet, M., Murphy, B., Shay, J., & Horrobin, D. (1998). Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biological Psychiatry, 43(5), 315–319.

    Article  PubMed  CAS  Google Scholar 

  25. Edwards, R., Peet, M., Shay, J., & Horrobin, D. (1998). Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. Journal of Affective Disorders, 48(2–3), 149–155.

    Article  PubMed  CAS  Google Scholar 

  26. Maes, M., Christophe, A., Delanghe, J., Altamura, C., Neels, H., & Meltzer, H. Y. (1999). Lowered omega 3 polyunsaturated fatty acids in serum phospholipids and cholesteryl esters of depressed patients. Psychiatry Research, 85(3), 275–291.

    Article  PubMed  CAS  Google Scholar 

  27. Mamalakis, G., Jansen, E., Cremers, H., Kiriakakis, M., Tsibinos, G., & Kafatos, A. (2006). Depression and adipose and serum cholesteryl ester polyunsaturated fatty acids in the survivors of the seven countries study population of Crete. European Journal of Clinical Nutrition, 60(8), 1016–1023. doi:10.1038/sj.ejcn.1602413.

    Article  PubMed  CAS  Google Scholar 

  28. McNamara, R. K., Hahn, C. G., Jandacek, R., et al. (2007). Selective deficits in the omega-3 fatty acid docosahexaenoic acid in the postmortem orbitofrontal cortex of patients with major depressive disorder. Biological Psychiatry, 62(1), 17–24. doi:10.1016/j.biopsych.2006.08.026.

    Article  PubMed  CAS  Google Scholar 

  29. Maes, M., Smith, R., Christophe, A., Cosyns, P., Desnyder, R., & Meltzer, H. (1996). Fatty acid composition in major depression: Decreased omega 3 fractions in cholesteryl esters and increased C20:4 omega 6/C20:5 omega 3 ratio in cholesteryl esters and phospholipids. Journal of Affective Disorders, 38(1), 35–46.

    Article  PubMed  CAS  Google Scholar 

  30. Tiemeier, H., van Tuijl, H. R., Hofman, A., Kiliaan, A. J., & Breteler, M. M. B. (2003). Plasma fatty acid composition and depression are associated in the elderly: The Rotterdam Study. American Journal of Clinical Nutrition, 78(1), 40–46.

    PubMed  CAS  Google Scholar 

  31. Feart, C., Peuchant, E., Letenneur, L., et al. (2008). Plasma eicosapentaenoic acid is inversely associated with severity of depressive symptomatology in the elderly: Data from the Bordeaux sample of the Three-City Study. American Journal of Clinical Nutrition, 87(5), 1156–1162.

    PubMed  CAS  Google Scholar 

  32. Tang, W. H. W., & Samara, M. A. (2011). Polyunsaturated Fatty acids in heart failure: Should we give more and give earlier? Journal of the American College of Cardiology, 57(7), 880–883.

    Article  PubMed  CAS  Google Scholar 

  33. Calder, P. C. (1998). Immunoregulatory and anti-inflammatory effects of n-3 polyunsaturated fatty acids. Brazilian Journal of Medical and Biological Research, 31(4), 467–490.

    Article  PubMed  CAS  Google Scholar 

  34. Heller, A. T. J., & Koch, T. (2003). Fish or chips? News in Physiological Sciences, 18, 50–54.

    PubMed  CAS  Google Scholar 

  35. Simopoulos, A. P. (2002). The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomedicine & Pharmacotherapy, 56(8), 365–379.

    Article  CAS  Google Scholar 

  36. Christensen, J. H., Christensen, M. S., Dyerberg, J., & Schmidt, E. B. (1999). Heart rate variability and fatty acid content of blood cell membranes: A dose-response study with n-3 fatty acids. American Journal of Clinical Nutrition, 70(3), 331–337.

    PubMed  CAS  Google Scholar 

  37. Ghio, S., Scelsi, L., Latini, R., et al. (2010). Effects of n-3 polyunsaturated fatty acids and of rosuvastatin on left ventricular function in chronic heart failure: A substudy of GISSI-HF trial. European Journal of Heart Failure: Journal of the Working Group on Heart Failure of the European Society of Cardiology, 12(12), 1345–1353.

    CAS  Google Scholar 

  38. Nodari, S., Triggiani, M., Campia, U., et al. (2011). Effects of n-3 Polyunsaturated Fatty Acids on Left Ventricular Function and Functional Capacity in Patients With Dilated Cardiomyopathy. Journal of the American College of Cardiology, 57(7), 870–879.

    Article  PubMed  CAS  Google Scholar 

  39. Lin, P. Y., & Su, K. P. (2007). A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. The Journal of Clinical Psychiatry, 68(7), 1056–1061.

    Article  PubMed  CAS  Google Scholar 

  40. Richardson, A. J. (2008). n-3 fatty acids and mood: The devil is in the detail. British Journal of Nutrition, 99(2), 221–223. doi:10.1017/s0007114507824123.

    Article  PubMed  CAS  Google Scholar 

  41. Ross, B. M. (2008). The emerging role of eicosapentaenoic acid as an important psychoactive natural product: Some answers but a lot more questions. Lipid Insights, 2, 98–7.

    Google Scholar 

  42. Burdge, G. C., & Wootton, S. A. (2002). Conversion of alpha-linolenic acid to eicosapentaenoic, docosapentaenoic and docosahexaenoic acids in young women. British Journal of Nutrition, 88(4), 411–420. doi:10.1079/bjn2002689.

    Article  PubMed  CAS  Google Scholar 

  43. Burdge, G. C., & Calder, P. C. (2005). Conversion of alpha-linolenic acid to longer-chain polyunsaturated fatty acids in human adults. Reproduction Nutrition Development, 45(5), 581–597. doi:10.1051/rnd:2005047.

    Article  CAS  Google Scholar 

  44. Burdge, G. C., Jones, A. E., & Wootton, S. A. (2002). Eicosapentaenoic and docosapentaenoic acids are the principal products of alpha-linolenic acid metabolism in young men. British Journal of Nutrition, 88(4), 355–363. doi:10.1079/bjn2002662.

    Article  PubMed  CAS  Google Scholar 

  45. Arterburn, L. M., Hall, E. B., & Oken, H. (2006). Distribution, interconversion, and dose response of n-3 fatty acids in humans. American Journal of Clinical Nutrition, 83(6), 1467S–1476S.

    PubMed  CAS  Google Scholar 

  46. Cho, H. P., Nakamura, M., & Clarke, S. D. (1999). Cloning, expression, and fatty acid regulation of the human delta-5 desaturase. Journal of Biological Chemistry, 274(52), 37335–37339.

    Article  PubMed  CAS  Google Scholar 

  47. Xie LaI, S. M. (2010). Association of fatty acid desaturase gene polymorphisms with blood lipid essential fatty acids and perinatal depression among Canadian women: a pilot study. Journal of Nutrigenetics and Nutrigenomics, 2(4–5), 243–250.

    Google Scholar 

  48. Lalovic, A., Klempan, T., Sequeira, A., Luheshi, G., & Turecki, G. (2010). Altered expression of lipid metabolism and immune response genes in the frontal cortex of suicide completers. Journal of Affective Disorders, 120(1–3), 24–31. doi:10.1016/j.jad.2009.04.007.

    Article  PubMed  CAS  Google Scholar 

  49. BoltonSmith, C., Woodward, M., & Tavendale, R. (1997). Evidence for age-related differences in the fatty acid composition of human adipose tissue, independent of diet. European Journal of Clinical Nutrition, 51(9), 619–624.

    Article  CAS  Google Scholar 

  50. Bordoni, A., Biagi, P. L., Turchetto, E., & Hrelia, S. (1988). Aging influence on delta-6-desaturase activity and fatty-acid composition of rat-liver microsomes. Biochemistry International, 17(6), 1001–1009.

    PubMed  CAS  Google Scholar 

  51. Bourre, J. M., & Piciotti, M. (1997). Alterations in eighteen-carbon saturated, monounsaturated and polyunsaturated fatty acid peroxisomal oxidation in mouse brain during development and aging. Biochemistry and Molecular Biology International, 41(3), 461–468.

    PubMed  CAS  Google Scholar 

  52. Hrelia, S., Bordoni, A., Celadon, M., Turchetto, E., Biagi, P. L., & Rossi, C. A. (1989). Age-related-changes in linoleate and alpha-linolenate desaturation by rat-liver microsomes. Biochemical and Biophysical Research Communications, 163(1), 348–355.

    Article  PubMed  CAS  Google Scholar 

  53. Maniongui, C., Blond, J. P., Ulmann, L., Durand, G., Poisson, J. P., & Bezard, J. (1993). Age-related-changes in delta-6 and delta-5 desaturase activities in rat-liver microsomes. Lipids, 28(4), 291–297.

    Article  PubMed  CAS  Google Scholar 

  54. Perichon, R., & Bourre, J. M. (1995). Peroxisomal beta-oxidation activity and catalase activity during development and aging in mouse-liver. Biochimie, 77(4), 288–293.

    Article  PubMed  CAS  Google Scholar 

  55. Appleton, K. H. R., Gunnell, D., Peters, T., Rogers, P., Kessler, D., & Ness, A. (2006). Effects of n-3 long-chain polyunsaturated fatty acids on depressed mood: Systemic review of published trials. American Journal of Clinical Nutrition, 84, 1308–1316.

    PubMed  CAS  Google Scholar 

  56. Appleton, K. M., Rogers, P. J., & Ness, A. R. (2010). Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. American Journal of Clinical Nutrition, 91(3), 757–770. doi:10.3945/ajcn.2009.28313.

    Article  PubMed  CAS  Google Scholar 

  57. Carney, R. M., Freedland, K. E., & Steinmeyer, B. C. (2010). Omega-3 fatty acids for CHD with depression reply. Jama-Journal of the American Medical Association, 303(9), 836.

    Article  CAS  Google Scholar 

  58. Lesperance, F., Frasure-Smith, N., St-Andre, E., Turecki, G., Lesperance, P., & Wisniewski, S. R. (2010). The efficacy of omega-3 supplementation for major depression: A randomized controlled trial. The Journal of Clinical Psychiatry. doi:10.4088/JCP.10m05966blu.

  59. Kromhout, D., Giltay, E. J., & Geleijnse, J. M. (2010). n–3 Fatty acids and cardiovascular events after myocardial infarction. The New England Journal of Medicine. doi:10.1056/NEJMoa1003603.

Download references

Acknowledgements

The authors would like to thank Eileen Bailey-Hall of Martek Biosciences Corporation, Columbia, MD and the Martek Biosciences Corporation for the significant contribution in regards to processing plasma samples and the FA analysis. We would also like to thank Dr. Steve Rozen of the Duke-NUS Graduate Medical School Singapore in Singapore for his contribution of data analysis and interpretation.

Funding Sources

The study was funded by the SADHART-CHF study (R01-MH063211) and R21 MH076178 by the National Institute of Mental Health (NIMH) Bethesda, Maryland.

Financial Disclosures

• Dr. Jiang received salary support through the NIMH research grant, and a minority supplement award for the biomarker study affiliated to the SADHART-CHF grant.

• Dr. O'Connor has received salary support through the NIMH research grant and is a consultant for Martek Biosciences Corporation.

• Dr. Kuchibhatla received salary support through the NIMH research grant.

• Dr. Cuffe has received salary support through the NIMH research grant.

• Dr. Krishnan has received salary support through the NIMH research grant.

• Dr. Martsberger has received salary support from the NIMH research grant.

• Linda Shaw: nothing to disclose for this study.

• Dr. Fiuzat: nothing to disclose for this study.

• Dr. Oken is a consultant to the Martek Biosciences Corporation.

• Dr. Kaddurah-Daouk: nothing to disclose for this study.

• Dr. Steffens has received salary support from NIMH for the metabolomic study.

• Dr. Baillie: nothing to disclose for this study.

All authors had access to the data. The preliminary result of the omega fatty acid study was presented at the 2010 American College of Cardiology Annual Meeting in March 2010 in Atlanta, GA.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Wei Jiang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jiang, W., Oken, H., Fiuzat, M. et al. Plasma Omega-3 Polyunsaturated Fatty Acids and Survival in Patients with Chronic Heart Failure and Major Depressive Disorder. J. of Cardiovasc. Trans. Res. 5, 92–99 (2012). https://doi.org/10.1007/s12265-011-9325-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12265-011-9325-8

Keywords

Navigation