PREVENZIONE SECONDARIA (POST-INFARTO)

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Am J Clin Nutr. 2003 Jul;78(1):65-71.  Comment in:        Am J Clin Nutr. 2003 Jul;78(1):1-2.

 
n-3 Fatty acids and 5-y risks of death and cardiovascular disease events in patients with coronary artery disease.

Erkkila AT, Lehto S, Pyorala K, Uusitupa MI.

Department of Clinical Nutrition, University of Kuopio and Kuopio University Hospital, Kuopio, Finland. arja.erkkila@tufts.edu

BACKGROUND: Data on the association of n-3 fatty acid content in serum lipids with mortality in patients with coronary artery disease (CAD) are limited. 

OBJECTIVE: We hypothesized that a high proportion of n-3 fatty acids in serum lipids would be associated with reduced risks of death and coronary events in patients with established CAD. DESIGN: We measured dietary intakes via food records and the fatty acid composition of serum cholesteryl esters (CEs) in 285 men and 130 women with CAD (x age: 61 y; range: 33-74 y). The patients participating in the EUROASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) study were followed up for 5 y. 

RESULTS: During the follow-up, 36 patients died, 21 had myocardial infarctions, and 12 had strokes. The relative risks (RRs) of death adjusted for cardiovascular disease risk factors for subjects in the highest tertile of fatty acids in CEs compared with those in the lowest tertile were 0.33 (95% CI: 0.11, 0.96) for alpha-linolenic acid, 0.33 (0.12, 0.93) for eicosapentaenoic acid, and 0.31 (0.11, 0.87) for docosahexaenoic acid (P for trend = 0.063, 0.056, and 0.026, respectively). A high proportion of eicosapentaenoic acid in CEs was associated with a low risk of CAD death. Compared with no consumption, consumption of fish tended to be associated with a lower risk of death [1-57 g/d, RR = 0.50 (0.20, 1.28); > 57 g/d, RR = 0.37 (0.14, 1.00); P for trend = 0.059]. 

CONCLUSION: High proportions of n-3 fatty acids in serum lipids are associated with a substantially reduced risk of death.

Cardiovasc Drugs Ther 1997 Jul;11(3):485-91

Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival--4.

Singh RB, Niaz MA, Sharma JP, Kumar R, Rastogi V, Moshiri M.

Heart Research Laboratory, Medical Hospital and Research Centre, Civil Lines, Moradabad, India.

In a randomized, placebo-controlled trial, the effects of treatment with fish oil (eicosapentaenoic acid, 1.08 g/day) and mustard oil (alpha-linolenic acid, 2.9 g/day) were compared for 1 year in the management of 122 patients (fish oil, group A), 120 patients (mustard oil, group B), and 118 patients (placebo, group C) with suspected acute myocardial infarction (AMI).

NOTA: In Italia i farmaci integratori di omega-3 di pesce (es. SEACORE) forniscono 0,8 gr/g di EPA+DHA, pari a circa il 70-75 % di quanto usato in questo studio.    VitalOil fornisce 3 gr/g di ALA la medesima quantità dello studio.

Treatments were administered about (mean) 18 hours after the symptoms of AMI in all three groups.

The extent of cardiac disease, rise in cardiac enzymes, and lipid peroxides were comparable among the groups at entry into the study.

After 1 year total cardiac events were significantly less in the fish oil and mustard oil groups compared with the placebo group (24.5% and 28%  vs. 34.7%, p < 0.01).(pari ad una riduzione del - 19 % del gruppo ALA Vs controllo)

Nonfatal infarctions were also significantly less in the fish oil and mustard oil groups compared with the placebo group (13.0% and 15.0% vs. 25.4%, p a 0.05).(pari ad una riduzione del -41% del gruppo ALA Vs controllo)

Total cardiac deaths showed no significant reduction in the mustard oil group; however, the fish oil group had significantly less cardiac deaths compared with the placebo group (11.4% vs. 22.0%, p < 0.05).

Apart from the decrease in the cardiac event rate, the fish oil and mustard oil groups also showed a significant reduction in total cardiac arrhythmias, left ventricular enlargement, and angina pectoris compared with the placebo group.

Reductions in blood lipoproteins in the two intervention groups were modest and do not appear to be the cause of the benefit in the two groups.

Diene conjugates showed a significant reduction in the fish oil and mustard oil groups, indicating that a part of the benefit may be caused by the reduction in oxidative stress.

The findings of this study suggest that fish oil and mustard oil, possibly due to the presence of n-3 fatty acids, may provide rapid protective effects in patients with AMI. However, a large study is necessary to confirm this suggestion.

NOTA: IN CONSIDERAZIONE CHE LA TRASFORMAZIONE DELL'ALA IN EPA E DHA RAGGIUNGE IL PICCO DOPO DIVERSI MESI DALL'ASSUNZIONE, STUDI PIU' PROLUNGATI POTREBBERO ESSERE PIU' SIGNIFICATIVI  (VEDI STUDIO SEGUENTE).

Am J Clin Nutr 1995 Jun;61(6 Suppl):1360S-1367S 
Cretan Mediterranean diet for prevention of coronary heart disease.
Renaud S, de Lorgeril M, Delaye J, Guidollet J, Jacquard F, Mamelle N, Martin JL, Monjaud I, Salen P, Toubol P
INSERM Unit 63, Lyon-Bron, France. 

As a result of the Seven Countries Study, the Mediterranean diet has been popularized as a healthy diet. Nevertheless, it has not replaced the prudent diet commonly prescribed to coronary patients. Recently, we completed a secondary, randomized, prospective prevention trial in 605 patients recovering from myocardial infarction in which we compared an adaptation of the Cretan Mediterranean diet with the usual prescribed diet.
After a mean follow-up period of 27 mo, recurrent myocardial infarction, all cardiovascular events, and cardiac and total death were significantly decreased by > 70% in the group consuming the Mediterranean diet.
These protective effects were not related to serum concentrations of total, low-density-lipoprotein (LDL), or high-density-lipoprotein (HDL) cholesterol.
In contrast, protective effects were related to changes observed in plasma fatty acids: an increase in n-3 fatty acids and oleic acid and a decrease in linoleic acid that resulted from higher intakes of linolenic and oleic acids, but lower intakes of saturated fatty acids and linoleic acid. 
In addition, higher plasma concentrations of antioxidant vitamins C and E were observed. 
We conclude that a Cretan Mediterranean diet adapted to a Western population protected against coronary heart disease much more efficiently than did the prudent diet. Thus, it appears that the favorable life expectancy of the Cretans could be largely due to their diet. 

NOTA: 

E' da sottolineare (per eventuali confronti) che la minore mortalità è da riferirsi a 27 mesi: pari a ca. -36% annuo.

Il gruppo sperimentale ha incrementato il consumo di ALA utilizzando al posto del burro 19 gr/g di Margarina "arricchita" di ALA. 

Composizione della dieta (gr/g) (componente lipidica)