By: Jean Johnson for Heart1
For decades cardiologists around the world have asked the question: How can we best care for our hearts? One of the more compelling areas they have recently investigated is the influence of omega-3 fatty acids.
According to the American College of Cardiology (ACC), “for people 65 and older, eating fish just once or twice a week (in three to five-ounce servings) may help to: lower the resting heart rate, slow the time between when the heart is signaled to pump blood and the pumping occurs, and reduce the risk of the heart’s electrical system not resetting properly after each beat.
|While the studies have focused on fish, Whole Foods lists the following comparisons on “the world’s healthiest foods rich in omega-3 fatty acids”:
Flaxseeds: 95 calorie-portion or 2T; 140.4 percent of the daily value
Walnuts: 164 calorie-portion or 2.5T; 90.8 percent of the daily value
Salmon: 262 calorie-portion or 4oz baked or broiled; 83.6 percent of the daily value
Whole Foods also includes ground cloves, oregano, raw tofu, baked or broiled snapper, mustard seeds, cabbage, baked winter squash, baked or broiled scallops, halibut, and steamed or broiled shrimp as significant sources of omega-3 fatty acids.
“All these factors can play a role in sudden cardiac death, which claims the lives of hundreds of thousands of people every year,” adds the ACC.
The ACC is commenting on recent research published in the August 2006 issue of the Journal of the American College of Cardiology in which study leader Dariush Mozaffarian, M.D., DrPH, FACC, a cardiologist at Brigham and Women’s Hospital and instructor at Harvard Medical School in Boston, suggests that moderate consumption of fish positively influences heart function.
“The good news is that we’re not talking about a large amount of fish intake, or fish oil supplements, but rather modest fish intake – one or two servings per week,” Mozaffarian told the ACC. “But that modest intake may have important benefits.”
Fish and chips won’t do the job, says Mozaffarian.
“In contrast to intake of tuna or other broiled or baked fish, intake of fried fish had no association with the heart’s electrical parameters,” he said. “Previously, we have seen that intake of fried fish – which in the U.S. is most often commercially sold fish burgers or fish sticks – is not associated with blood levels of omega-3 fatty acids. This suggests that it may be the omega-3 fatty acids in tuna and other broiled or baked fish that are having a positive impact on the heart’s electrical parameters.”
Mozaffarian and his colleagues reached their conclusions after analyzing data from almost 6,000 participants in the Cardiovascular Health Study that began in 1989. They used a dietary questionnaire and compared the fish consumption of individuals to their electrocardiogram (ECK) results.
“Although the researchers noted increasing benefits with higher levels of fish consumption,” the ACC states, “most of the benefit was achieved by eating fish once or twice per week, particularly for heart rate,” Dr. Mozaffarian said.
Mozaffarian Study Adds Credence to American Heart Association Guidelines
Cardiologist Humberto Vidaillet, M.D., FACC, of Marshfield Clinic Research Foundation in Wisconsin was not involved in the research, but says the results corroborate the current thinking on the matter. “Based on previously-existing research on this topic, the American Heart Association already recommends eating fish twice a week as part of a diet that includes a variety of nutritious foods from all the food groups,” Vidaillet told the ACC. “Oily fish rich in omega-3 polyunsaturated fatty acids, such as salmon, trout, and herring, are particularly recommended.”
Like Mozaffarian, Vidaillet says that while most any fish “prepared by grilling, baking, or poaching” will fill the omega-3 fatty acid bill, “frying with added saturated or trans fats” does the heart no favors.
Instead, Vidaillet’s focus is on how the heart benefits from cuts of fish that are poached, grilled, or baked. “This new data provides further support for patients with a goal of reducing risk of death from coronary artery disease to follow such recommendations.”
Prescription Fish Oil
The New York Times ran a story on the discrepancies between the use of prescription fish oil after heart attacks in Europe and the United States.
“It is clearly recommended in international guidelines. It would be considered tantamount to malpractice in Italy to omit the drug.” Massimo Santini, M.D., chief of cardiology at San Filippo Neri Hospital in Rome told the NYT.
Santini added that “using this medicine is very popular here in Italy, I think partly because so many cardiologists in this country participated in the studies and were aware of the results. In other countries, the uptake may be harder because doctors think of it as just a dietary intervention.”
Despite large numbers of studies confirming the effectiveness of prescription fish oil in improving survival rates after a heart attack, the NYT says that “in the United States, heart attack victims are not generally given omega-3 fatty acids, even as they are routinely offered more expensive and invasive treatments, like pills to lower cholesterol or implantable defibrillators. Prescription fish oil, sold under the brand name Omacor, is not even approved by the Food and Drug Administration (FDA) for use in heart patients.”
That worries some in the field like Terry Jacobson, M.D., a preventive cardiologist at Emory University in Atlanta. “Most cardiologists here are not giving omega-3’s even though the data supports it – there’s a real disconnect,” he told the NYT. “They have been very slow to incorporate the therapy.
“If people paid more attention to the guidelines, more people would be on the drug,” Jacobson added. “But pharmaceutical companies can’t drive this change. The fact that it’s not licensed for this has definitely kept doctors away.”
Concerns in this area prompted the Journal of the American Board of Family Medicine to publish the results of a survey of family physicians in its September 2006 issue. Results showed that only 17 percent of the physicians “were likely to prescribe fish oil to their patients, including patients who had suffered a heart attack,” states the NYT.
As far as over-the-counter fish oil, the problem is that lack of quality control results in some companies selling blends of fish oils that don’t necessarily have the omega-3 fatty acid levels useful for heart health. Consequently, many physicians are simply telling patients to eat more fish. The problem is, however, that the recommended daily level is one gram of omega-3 fatty acid. It can be hard to consume this amount even if you do eat fish.
The FDA has questioned what it calls “methodological weaknesses” in the landmark Gissi-Prevenzione fish oil trial. “Patients treated with prescription fish oil pills were compared with untreated patients rather than with patients given a dummy pill,” the NYT writes. “This meant that despite impressive results, the trial did not meet the FDA’s standards for approval.”
According to the NYT, “by 2004, regulators in almost all European countries, including Spain, France, and Britain, had approved Omacor for use in heart attack patients.”