The Efficiency of Omega-3 Fatty Acid (Fish Oil) in Hyperlipidemia Treatment

Öz

Objectives: Such atherosclerosis-based diseases like coronary artery disease, myocardial infarction, and stroke are leading causes of morbidity and mortality. Hyperlipidemia is among the major risk factors for atherosclerotic diseases and results in accelerated atherosclerosis. Omega-3 fatty acids were reported to favorable effects on lipid profile, inflammation and blood pressure and to reduce rates of mortality associated with cardiovascular diseases. In this study we aimed to examine the effect of omega-3 fatty acid on lipid profile by comparing it with atorvastatin. Materials and Methods: The study registered 41 hyperlipidemic patients. The patients were randomized to two groups: the first group (n=20) was treated with 3 x 500 mg fish oil and the second group (n=21) with 20 mg/day atorvastatin. Serum lipid levels were examined and compared at the beginning of the treatment and in the third month. Results: It was observed that fish oil reduced total cholesterol by 19.2%, LDL by 21.2% and triglyceride by 21.2%, while atorvastatin treatment led to a decrease of 29.8% in total cholesterol, 26.8% in LDL and 25.9% in triglyceride. There was no statistically significant difference between the decreases in serum lipid levels of the groups. Although atorvastatin treatment did not change HDL levels, fish oil treatment brought about an increase in HDL levels. Blood pressures significantly decreased as a result of the treatment in both groups, but the increase in the fish oil group was more pronounced. Conclusion: Fish oil decreases total cholesterol, LDL and particularly triglyceride, levels, while increasing HDL levels. ©2006, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• -

Hiperlipidemi Tedavisinde Omega-3 Yağ Asitinin (Balık Yağı) Etkinliği

Öz

Amaç: Koroner arter hastalığı, miyokard infarktüsü, inme gibi ateroskleroz temelli hastalıklar önde gelen morbidite ve mortalite sebepleridir. Hiperlipidemi aterosklerotik hastalıkların majör risk faktörlerindendir ve hızlanmış ateroskleroz ile sonuçlanmaktadır. Omega-3 yağ asitlerinin lipit profili, inflamasyon, kan basıncı üzerine olumlu etkilerinin olduğu ve kardiovasküler hastalıklara bağlı mortalite oranlarını azalttığı rapor edilmiştir. Bu çalışmada omega-3 yağ asidinin lipit profili üzerine etkisini atorvastatin ile karşılaştırarak araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya 41 hiperlipidemik hasta alındı. Hastalar randomize olarak iki gruba ayrıldı, birinci grup; 3x500 mg balık yağı (n=20), ikinci grup; 20 mg/gün atorvastatin (n=21) ile tedavi edildi. Çalışma 3 ay sürdü. Tedavinin başlangıcında ve üçüncü aylarında serum lipit düzeylerine bakıldı ve karşılaştırıldı. Bulgular: 3 aylık tedavi sonrasında balık yağı ile total kolesterolde %19,2, LDL-kolesterolde %21,2, trigliseridde %28,7, atorvastatin tedavisi ile total kolesterolde %29,8, LDL-kolesterolde %26,8 ve trigliseridde %25,9 gerileme saptanmış olup her iki tedavinin etkisi bakımından istatistiksel fark bulunamadı. Atorvastatin HDL düzeylerini etkilemezken balık yağı tedavisi ile HDL düzeyinin arttığı gözlendi. Her iki grubun tedavi sonucunda balık yağı grubunda daha fazla olmak üzere kan basınçları anlamlı olarak geriledi. Sonuç: Omega-3 yağ asidi, trigliserid başta olmak üzere total kolesterol, LDL düzeylerini azaltmakta HDL düzeylerini de artırmaktadır. ©2006, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Hiperlipidemi, balık yağı, atorvastatin

Kaynakça

1. Ford ES, Giles WH, Mokdad AH. The distribution of 10-Year risk for coronary heart disease among US adults: findings from the National Health and Nutrition Examination Survey III. J Am Coll Cardiol. 2004; 43: 1791-1796.
2. Rosenson RS. Statins in atherosclerosis: lipid-lowering agents with antioxidant capabilities. Atherosclerosis. 2004; 173: 1-12.
3. Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension. 2001; 37: 1053- 1059.
4. Groop L, Orho-Melander M. The dysmetabolic syndrome. Intern Med. 2001; 250: 105-120.
5. Tokgözoğulu L, Özer N. Ateroskleroz patogenezi. Özcan N. Koroner kalp hastalıkları. 1. Baskı. Ankara 1997. 129-163.
6. Dyerberg J, Bang HO. A hypothesis on the development of acute myocardial infarction in Greenlanders. Scand J Clin Lab Invest Suppl. 1982; 161: 7-13.
7. Hergenç G. Ateroskleroza biyokimyasal yaklaşım. Görpe U, İlerigelen B. Ateroskleroz el kitabı. Ateroskleroz derneği yayınları. 1. baskı. İstanbul 2002: 16-35.
8. Durrington PN, Illingworth R. Lipid-lowering drugs: who gets what? Curr Opin Lipidol. 1998; 9: 289-294.

9. Kwak BR, Mulhaupt F, Mach F.Atherosclerosis: anti- inflammatory and immunomodulatory activities of statins. Autoimmun Rev. 2003; 2: 332-338.
10. Nordoy A, Bonaa KH, Nilsen H, Berge RK, Hansen JB, Ingebretsen OC. Effects of Simvastatin and omega-3 fatty acids on plasma lipoproteins and lipid peroxidation in patients with combined hyperlipidaemia. J Intern Med. 1998; 243: 163-170.
11. Nordoy A, Bonaa KH, Sandset PM, Hansen JB, Nilsen H. Effect of omega-3 fatty acids and simvastatin on hemostatic risk factors and postprandial hyperlipemia in patients with combined hyperlipemia. Arterioscler Thromb Vasc Biol. 2000; 20: 259-265.
12. 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.
13. Calabresi L, Villa B, Canavesi M, et al. An omega-3 polyunsaturated fatty acid concentrate increases plasma high- density lipoprotein 2 cholesterol and paraoxonase levels in patients with familial combined hyperlipidemia. Metabolism. 2004; 53: 153-158.
14. Chan DC, Watts GF, Mori TA, Barrett PH, Beilin LJ, Redgrave TG. Factorial study of the effects of atorvastatin and fish oil on dyslipidaemia in visceral obesity. Eur J Clin Invest. 2002; 32: 429-436.
15. Chan DC, Watts GF, Barrett PH, Beilin LJ, Mori TA. Effect of atorvastatin and fish oil on plasma high-sensitivity C-reactive protein concentrations in individuals with visceral obesity. Clin Chem. 2002; 48: 877-883.
16. Kris-Etherton PM, Harris WS, Appel LJ. Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease. Circulation. 2002; 106: 2747-2757.
17. Dolecek TA, Granditis G. Dietary polyunsaturated fatty acids and mortality in the Multiple Risk Factor Intervention Trial (MRFIT). World Rev Nutr Diet. 1991; 66: 205-216.
18. 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: 1046–53.
19. Zhang J, Sasaki S, Amano K, et al. Fish consumption and mortality from all causes, ischemic heart disease, and stroke: an ecological study. Prev Med. 1999; 28: 520–529.
20. Mizushima S, Moriguchi EH, Ishikawa P, et al. Fish intake and cardiovascular risk among middle-aged Japanese in Japan and Brazil. J Cardiovasc Risk. 1997; 4: 191–199.
21. 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.
22. Chan DC, Watts GF, Barrett PH, Beilin LJ, Redgrave TG, Mori TA. Regulatory effects of HMG CoA reductase inhibitor and fish oils on apolipoprotein B-100 kinetics in insulin-resistant obese male subjects with dyslipidemia. Diabetes. 2002 Aug; 51: 2377- 2386.
23. Park Y, Harris WS. Omega-3 fatty acid supplementation accelerates chylomicron triglyceride clearance. J Lipid Res. 2003; 44: 455-463.
24. Suzukawa M, Abbey M, Howe PR, Nestel PJ. Effects of fish oil fatty acids on low density lipoprotein size, oxidizability, and uptake by macrophages. Lipid Res. 1995; 36: 473-484.
25. Fox PL, DiCorleto PE.Fish oils inhibit endothelial cell production of platelet-derived growth factor-like protein. Science. 1988; 241: 453-456.
26. Harris WS, Dujovne CA, Zucker M, Johnson B. Effects of a low saturated fat, low cholesterol fish oil supplement in hypertriglyceridemic patients. A placebo-controlled trial. Ann Intern Med. 1988; 109:465-470.
27. Wilt TJ, Lofgren RP, Nichol KL, et al. Fish oil supplementation does not lower plasma cholesterol in men with hypercholesterolemia. Results of a randomized, placebo- controlled crossover study. Ann Intern Med. 1989; 111: 900-905.
28. Harris WS. n-3 Fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 1997; 65: 1645-1654.
29. Lewis A, Lookinland S, Beckstrand RL, Tiedeman ME. Treatment of hypertriglyceridemia with omega-3 fatty acids: a systematic review. Am Acad Nurse Pract. 2004; 16: 384-395.
30. Friedberg CE, Janssen MJ, Heine RJ, et al. Fish oil and glycemic control in diabetes: a meta-analysis. Diabetes Care 1998; 21: 494- 500.
31. Morris MC, Sacks F, Rosner B. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation. 1993; 88: 523-533.
32. Appel LJ, Miller ER3rd, 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.
33. Fogari R, Derosa G, Lazzari P, et al. Effect of amlodipine- atorvastatin combination on fibrinolysis in hypertensive hypercholesterolemic patients with insulin resistance. Am J Hypertens. 2004; 17: 823-827.
34. Paragh G, Torocsik D, Seres I, et al. Effect of short term treatment with simvastatin and atorvastatin on lipids and paraoxonase activity in patients with hyperlipoproteinaemia. Curr Med Res Opin. 2004; 20: 1321-1327.
35. Kabul Tarihi: 23.11.2005