Effects of Moderate-Dose Omega-3 Fish Oil on Cardiovascular Risk Factors and Mood After Ischemic Stroke

Abstract

Background and Purpose-Fish-derived omega-3 fatty acids have long been associated with cardiovascular protection. In this trial, we assessed whether treatment with a guideline-recommended moderate-dose fish oil supplement could improve cardiovascular biomarkers, mood-and health-related quality of life in patients with ischemic stroke. Methods-Patients with CT-confirmed stroke were randomized to 3 g/day encapsulated fish oil containing approximately 1.2 g total omega-3 (0.7 g docosahexaenoic acid; 0.3 g eicosapentaenoic acid) or placebo oil (combination palm and soy) taken daily over 12 weeks. Serum triglycerides, total cholesterol and associated lipoproteins, selected inflammatory and hemostatic markers, mood, and health-related quality of life were assessed at baseline and follow-up. The primary outcome was change in triglycerides. Compliance was assessed by capsule count and serum phospholipid omega-3 levels (Australian Clinical Trials Registration: ACTRN12605000207617). Results-One hundred two patients were randomized to fish oil or placebo. Intention-to-treat and per-protocol (Ͼ85% compliance) analyses showed no significant effect of fish oil treatment on any lipid, inflammatory, hemostatic, or composite mood parameters measured. Adherence to treatment based on pill count was good (89%) reflected by increased serum docosahexanoic acid (PϽ0.001) and eicosapentaenoic acid (Pϭ0.0006) in the fish oil group. Analysis of oil composition, however, showed some degradation and potentially adverse oxidation products at the end of the study. Conclusions-There was no effect of 12 weeks of treatment with moderate-dose fish oil supplements on cardiovascular biomarkers or mood in patients with ischemic stroke. It is possible that insufficient dose, short duration of treatment, and/or oxidation of the fish oils may have influenced these outcomes. (Stroke. 2009;40:3485-3492.)

Omega-3 Fatty Acid Blood Levels

“…36 Finally, in stroke patients treated with a more common clinical dose of 1.2 g/d total omega-3 fatty acids, EPA increased from 1.24±0.91% to 1.63±0.72%, DHA increased from 3.90±1.12% to 5.29±1.31%, and compliance was reported to be 90%. 29 The wide range of blood levels in these studies reflects the substantial individual variability in response to a fixed dose. …”

Dietary Intake and Intervention in Chronic Stroke: Review of the Evidence

“…An early study by Green et al [43] found no effect on cholesterol fraction or platelet function following a small daily dose of EPA (1.8 g) for six weeks in subjects with previous stroke or transient ischemic attacks. Similarly, in survivors >3 months post stroke, a 12 week supplementation of 3 g of fish oil (300 mg EPA and 700 mg DHA) per day did not result in significant effects on serum lipids, inflammation, or hemostatic markers [44]. Conversely, in the JELIS trial [45], which examined the additive effects of 1800 mg EPA to statin therapy, stroke survivors supplemented daily for around five years showed a 20% relative reduction in recurrent stroke compared to statin therapy alone.…”

“…The lack of an effect of fish oils on health related QOL or measures of anxiety, insomnia, and depression, were suggested by a previous study in stroke survivors (>3 months post stroke) that were supplemented for 12 weeks with 3 g of fish oil containing 700 mg DHA and 300 mg EPA [44]. However, supplementation with several micronutrients, including several B vitamins, in those with chronic heart failure, has resulted in improvements in QOL previously [67].…”

Novel venous thromboembolic disease (VTED) prophylaxis for total knee arthroplasty—aspirin and fish oil

“…In a randomized control trial Poppitt et al (36) analyzed 102 patients who were randomized to either 3 g/day of fish oil or placebo for 12 weeks. Although the group concluded there was no effect of 12 weeks of treatment on any lipid, inflammatory, or hemostatic biomarkers, the authors acknowledge the lack of cardiovascular improvement in these patients to be potentially due to insufficient dosage.…”