Congestive Heart Failure (CHF)
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Congestive Heart Failure (CHF) and Essential Fatty Acids

Written by ColleenO, FoundHealth.

Supplementing with fish oil may modestly reduce the risk of death or admission to the hospital for cardiovascular reasons in patients suffering from congestive heart failure (CHF). The omega-3 fatty acids in fish oil have a number of potential benefits for general heart health. A significant amount of research has been done on fish oil/omega-3s and heart-related conditions, including CHF.

Effect of Essential Fatty Acids on Congestive Heart Failure (CHF)

Fish oil may have a number of beneficial effects on congestive heart failure. Fish oil has been shown to reduce triglyceride levels, raise HDL ("good") cholesterol levels, "thin" the blood, lower levels of homocysteine, prevent dangerous heart arrhythmias, slow heart rate, improve blood vessel tone, and decrease blood pressure.14,15,51,90-94,96-105,151,160-165,174,177,189,190,203-204,238

Read more details about Essential Fatty Acids.

Research Evidence on Essential Fatty Acids

A large Italian trial involving almost 7,000 subjects found that fish oil may modestly reduce the risk of death or admission to the hospital for cardiovascular reasons in patients suffering from congestive heart failure.67

How to Use Essential Fatty Acids

Typical dosages of fish oil are 3 g to 9 g daily, but this is not the upper limit. In one study, participants ingested 60 g daily.

The most important omega-3 fatty acids found in fish oil are called eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In order to match the dosage used in several major studies, you should take enough fish oil to supply about 2 g to 3 g of EPA (2,000 mg to 3,500 mg) and about 1.0 g to 2.5 g of DHA daily (1,000 mg to 2,500 mg). Far higher doses have been used in some studies; conversely, one study found blood-pressure lowering effects with a very low daily dosage of DHA—0.7 g.238

DHA and EPA are not identical and might not have identical effects. Some evidence hints that DHA may be more effective than EPA for thinning the blood 176 and reducing blood pressure.105 The reverse may be true for reducing triglyceride levels, but study results are conflicting.160-165,235

Some manufacturers add vitamin E to fish oil capsules to keep the oil from becoming rancid. Another method is to remove all the oxygen from the capsule.

If possible, purchase fish oil products certified as free of significant levels of mercury, toxic organochlorines, and PCBs (see Safety Issues).

Flaxseed oil also contains omega-3 fatty acids, although of a different kind. It has been suggested as a less smelly substitute for fish oil. However, it is far from clear whether flaxseed oil is therapeutically equivalent to fish oil.1,200

Types of Professionals That Would Be Involved with This Treatment

  • Integrative MD
  • Naturopathic doctor
  • Clinical nutritionist or registered dietitian

Safety Issues

Fish oil appears to be generally safe. The most common problem is fishy burps. However, there are some safety concerns to consider.

For example, it has been suggested that some fish oil products contain excessive levels of toxic substances such as organochlorines and PCBs. 1 If possible, try to purchase fish oil products certified not to contain significant levels of these contaminants. Note:Various types of fish contain mercury, but this has not been a problem with fish oil supplements, according to reports on Consumerlab.com.

Fish oil has a mild blood-thinning effect; 2 in one case report, it increased the effect of the blood-thinning medication warfarin (Coumadin). 3 Fish oil does not seem to cause bleeding problems when it is taken by itself 4 or with aspirin. 5 Nonetheless, people who are at risk of bleeding complications for any reason should consult a physician before taking fish oil.

Fish oil does not appear to raise blood sugar levels in people with diabetes. 6 Nonetheless, if you have diabetes, you should not take any supplement except on the advice of a physician.

Fish oil may modestly increase weight and lower total cholesterol and HDL (“good”) cholesterol levels. 7 It may also raise the level of LDL ("bad") cholesterol; however, this effect may be short-lived. 8 If you decide to use cod liver oil as your fish oil supplement, make sure you do not exceed the safe maximum intake of vitamin A and vitamin D . These vitamins are fat soluble, which means that excess amounts tend to build up in your body, possibly reaching toxic levels. The official maximum daily intake of vitamin A is 3,000 mcg for pregnant women as well as other adults. Look at the bottle label to determine how much vitamin A you are receiving. (It is less likely that you will get enough vitamin D to produce toxic effects.)

Interactions You Should Know About

If you are taking warfarin (Coumadin) or heparin , do not take fish oil except on the advice of a physician.

References

  1. Jacobs MN, Santillo D, Johnston PA, Wyatt CL, French MC. Organochlorine residues in fish oil dietary supplements: comparison with industrial grade oils. Chemosphere. 37(9-12):1709-21.
  2. Emsley R, Niehaus DJ, Oosthuizen PP, Koen L, Ascott-Evans B, Chiliza B, van Rensburg SJ, Smit RM. Safety of the omega-3 fatty acid, eicosapentaenoic acid (EPA) in psychiatric patients: results from a randomized, placebo-controlled trial. Psychiatry Res. 161(3):284-91.
  3. Buckley MS, Goff AD, Knapp WE. Fish oil interaction with warfarin. Ann Pharmacother. 38(1):50-2.
  4. Harris WS. Dietary fish oil and blood lipids. Curr Opin Lipidol. 7(1):3-7.
  5. Leaf A, Jorgensen MB, Jacobs AK, Cote G, Schoenfeld DA, Scheer J, Weiner BH, Slack JD, Kellett MA, Raizner AE. Do fish oils prevent restenosis after coronary angioplasty? Circulation. 90(5):2248-57.
  6. Harris WS. Dietary fish oil and blood lipids. Curr Opin Lipidol. 7(1):3-7.
  7. Emsley R, Niehaus DJ, Oosthuizen PP, Koen L, Ascott-Evans B, Chiliza B, van Rensburg SJ, Smit RM. Safety of the omega-3 fatty acid, eicosapentaenoic acid (EPA) in psychiatric patients: results from a randomized, placebo-controlled trial. Psychiatry Res. 161(3):284-91.
  8. Cobiac L, Clifton PM, Abbey M, Belling GB, Nestel PJ. Lipid, lipoprotein, and hemostatic effects of fish vs fish-oil n-3 fatty acids in mildly hyperlipidemic males. Am J Clin Nutr. 53(5):1210-6.
  1. Harris WS. N-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 1997;65(suppl 5 ):S1645-S1654.
  2. Montori VM, Farmer A, Wollan PC, et al. Fish oil supplementation in type 2 diabetes: a quantitative systematic review. Diabetes Care. 2000;23:1407-1415.
  3. Durrington PN, Bhatnagar D, Mackness MI, et al. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. Heart. 2001;85:544-548.
  4. Lorenz R, Weber PC, Szimnau P, et al. Supplementation with n-3 fatty acids from fish oil in chronic inflammatory bowel disease—a randomized, placebo-controlled, double-blind cross-over trial. J Intern Med Suppl. 1989;225:225-232.
  5. Gissi-Hf Investigators. 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. 2008 Aug 29. [Epub ahead of print]
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  7. Durrington PN, Bhatnagar D, Mackness MI, et al. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. Heart. 2001;85:544-548.
  8. Harris WS. N-3 fatty acids and lipoproteins: comparison of results from human and animal studies. Lipids. 1996;31:243-252.
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  18. Appel LJ, Miller ER III, Seidler AJ, et al. Does supplementation of diet with 'fish oil' reduce blood pressure? A meta-analysis of controlled clinical trials. Arch Intern Med. 1993;153:1429-1438.
  19. Whelton PK, Kumanyika SK, Cook NR, et al. Efficacy of nonpharmacologic interventions in adults with high-normal blood pressure: Results from phase 1 of the Trials of Hypertension Prevention. Am J Clin Nutr. 1997;65(suppl 2):S652-S660.
  20. Mori TA, Bao DQ, Burke V, et al. Docosahexaenoic acid but not eicosapentaenoic acid lowers ambulatory blood pressure and heart rate in humans. Hypertension. 1999;34:253-260.
  21. Yam D, et. al. The effect of omega-3 fatty acids on risk factors for cardiovascular diseases. Harefuah. 2001;140:1156-1158.
  22. Mori TA, Burke V, Puddey IB, et al. Purified eicosapentaenoic and docosahexaenoic acids have differential effects on serum lipids and lipoproteins, LDL particle size, glucose, and insulin in mildly hyperlipidemic men. Am J Clin Nutr. 2000;71:1085-1094.
  23. Rambjor GS, Walen AI, Windsor SL Eicosapentaenoic acid is primarily responsible for hypotriglyceridemic effect of fish oil in humans. Lipids. 1996;31(suppl):45-49.
  24. Agren JJ, Hanninen O, Julkunen A, et al. Fish diet, fish oil and docosahexaenoic acid rich oil lower fasting and postprandial plasma lipid levels. Eur J Clin Nutr. 1996;50:765-771.
  25. Childs MT, King IB, Knopp RH. Divergent lipoprotein responses to fish oils with various ratios of eicosapentaenoic acid and docosahexaenoic acid. Am J Clin Nutr. 1990;52:632-639.
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  27. Leigh-Firbank EC, Minihane AM, Minihane AM, et al. Eicosapentaenoic acid and docosahexaenoic acid from fish oils: differential associations with lipid responses. Br J Nutr. 2002;87:435-445.
  28. Geleijnse JM, Giltay EJ, Grobbee DE, et al. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens. 2002;20:1493-1499.
  29. Mangoni AA, Sherwood RA, Swift CG, et al. Folic acid enhances endothelial function and reduces blood pressure in smokers: a randomized controlled trial. J Intern Med. 2002;252:497-503.
  30. Khan F, Elherik K, Bolton-Smith C, et al. The effects of dietary fatty acid supplementation on endothelial function and vascular tone in healthy subjects. Cardiovasc Res. 2003;59:955-962.
  31. Grundt H, Nilsen DW, Mansoor MA, et al. Reduction in homocysteine by n-3 polyunsaturated fatty acids after 1 year in a randomised double-blind study following an acute myocardial infarction: no effect on endothelial adhesion properties. Pathophysiol Haemost Thromb. 2003;33:88-95.
  32. Harper CR, Edwards MJ, Defilipis AP, et al. Flaxseed Oil Increases the Plasma Concentrations of Cardioprotective (n-3) Fatty Acids in Humans. J Nutr. 2005;136:83-87.
  33. Mozaffarian D, Geelen A, Brouwer IA, et al. Effect of fish oil on heart rate in humans. A meta-analysis of randomized controlled trials. Circulation. 2005 Sep 19. [Epub ahead of print]
  34. Balk EM, Lichtenstein AH, Chung M, et al. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: A systematic review. Atherosclerosis. 2006 Mar 9. [Epub ahead of print]
  35. Schwellenbach LJ, Olson KL, McConnell KJ, et al. The triglyceride-lowering effects of a modest dose of docosahexaenoic acid alone versus in combination with low-dose eicosapentaenoic acid in patients with coronary artery disease and elevated triglycerides. J Am Coll Nutr. 2006;25:480-485.
  36. Theobald HE, Goodall AH, Sattar N, et al. Low-dose docosahexaenoic acid lowers diastolic blood pressure in middle-aged men and women. J Nutr. 2007;137:973-978.

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