EPA’s pleiotropic mechanisms of action: a narrative review

Nelson, John; Budoff, Matthew J.; Wani, Omar R; Le, Viet T; Patel, Dhiren; Nelson, Ashley D.; Nemiroff, Robert J.

doi:10.1080/00325481.2021.1921491

Cited by 26 publications

(13 citation statements)

References 160 publications

(182 reference statements)

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“…It does not appear to lower LDL-C levels, but pleiotropic antiplatelet properties have been suggested. 58 In the REDUCE-IT trial (Cardiovascular Risk Reduction With Icosapent Ethyl for Hypertriglyceridemia), participants with elevated triglyceride levels on statin therapy and established cardiovascular disease or diabetes and other risk factors randomized to icosapent ethyl had an 18% reduction in their baseline triglyceride levels over a median follow-up of 5 years. 59 This was accompanied by a 25% reduction in major cardiovascular events, including a 36% risk reduction in ischemic stroke and 20% reduction in cardiovascular death.…”

Section: Other Lipid-lowering Therapiesmentioning

confidence: 99%

Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage

Shoamanesh

Selim

2022

Stroke

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Hyperlipidemia is common in patients with intracerebral hemorrhage (ICH). Accumulating evidence indicates that patients with ICH are at risk for future hemorrhage recurrence, cardiovascular disease, and ischemic stroke and highlights the importance of secondary prevention of vascular events after ICH. Although the benefits of intensive treatment of hyperlipidemia for reducing ischemic cardiac and vascular events in patients with ischemic stroke are well established, the benefit versus harm in patients with ICH are less clear. Epidemiological studies suggest that hyperlipidemia is protective against ICH and that intensive lowering of lipids is associated with increased risk for ICH. Similarly, although currently available lipid-lowering treatments have been thoroughly studied in patients with ischemic cardiac and vascular disease, only few randomized trials of these therapies included a very small number of patients with history of ICH. Thus, limiting any definitive conclusions regarding the safety and net benefit of these treatments in ICH populations. Currently, there is no consensus regarding the optimal strategy for management of hyperlipidemia after ICH. In this article, we review relevant literature to outline the competing risks and benefits of lipid-lowering treatments in this vulnerable patient population. We suggest a treatment paradigm based on available data but note that data from dedicated randomized trials are needed to build the necessary evidence to guide optimal lipid-lowering strategy in patients with a history of ICH.

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Section: Other Lipid-lowering Therapiesmentioning

confidence: 99%

Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage

Shoamanesh

Selim

2022

Stroke

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“…Instead the formation of pro-inflammatory mediators like prostaglandins or thromboxanes from the arachidonic acid (AA), the release of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) results in formation of anti-inflammatory mediators like resolvins and protectins. These inhibit pro-inflammatory cytokines [220]. In addition to omega-3 FA's anti-inflammatory effect, its double bonds are prone to oxidation, so it subsequently activates the Nrf2-pathway promoting endogenous anti-oxidative mechanisms [221].…”

Section: Antiarrhythmic Efficacy Of Omega-3 Fatty Acidsmentioning

confidence: 99%

Mechanisms Underlying Antiarrhythmic Properties of Cardioprotective Agents Impacting Inflammation and Oxidative Stress

Andelová

Bacova

Sýkora

et al. 2022

IJMS

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The prevention of cardiac life-threatening ventricular fibrillation and stroke-provoking atrial fibrillation remains a serious global clinical issue, with ongoing need for novel approaches. Numerous experimental and clinical studies suggest that oxidative stress and inflammation are deleterious to cardiovascular health, and can increase heart susceptibility to arrhythmias. It is quite interesting, however, that various cardio-protective compounds with antiarrhythmic properties are potent anti-oxidative and anti-inflammatory agents. These most likely target the pro-arrhythmia primary mechanisms. This review and literature-based analysis presents a realistic view of antiarrhythmic efficacy and the molecular mechanisms of current pharmaceuticals in clinical use. These include the sodium‑glucose cotransporter-2 inhibitors used in diabetes treatment, statins in dyslipidemia and naturally protective omega-3 fatty acids. This approach supports the hypothesis that prevention or attenuation of oxidative and inflammatory stress can abolish pro-arrhythmic factors and the development of an arrhythmia substrate. This could prove a powerful tool of reducing cardiac arrhythmia burden.

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“…DHA is abundant in nerve tissue and has obvious effects on neurons and retinal membrane tissue. EPA has the ability to reduce inflammation, cholesterol crystal formation, endothelial dysfunction and markers of oxidative modification of various ApoBcontaining lipoprotein particles and to increase highdensity lipoprotein [24][25][26] . The EVAPORATE trial compared the effects of high-dose purified EPA with mineral oil plus statin versus statin alone on coronary plaque and claimed a slight "regression" of coronary plaque in the EPA plus statin group.…”

Section: Inspirations From Comparing Reduce-it and Strenth: The Type ...mentioning

confidence: 99%

Is Omega-3 Index necessary for fish oil supplements for CVD risk prevention?

Chen

2022

Cardiology Plus

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Several large prospective cohort studies demonstrated an association between higher cardiovascular disease (CVD) risk with low blood level of omega-3 fatty acids as well as low Omega-3 Index [<4% eicosapentaenoic acid (EPA)+ docosahexaenoic acid (DHA) to total fatty acids in red blood cell membrane]. However, randomized controlled trials of omega-3 fatty acids as either primary or secondary prevention have yielded controversial results. In this review, we summarize the evidence that supports or argues against the use omega-3 fatty acids, with a focus on the underlying mechanisms for the observed discrepancies (eg, differences in dosage, comparators and EPA levels or Omega-3 Index). Omega-3 Index is an independent risk factor for cardiovascular risk. The baseline Omega-3 Index can be used as a reference for whether and how much fish oil should be supplemented. To some degree, it can be used to explain why there are so much inconsistencies in clinical trials. Omega-3 Index could be a promising treatment target in clinical practice and in public health settings although there are still some barriers. This review summarizes current evidences from both epidemiological studies and randomized controlled trials of omega-3 fatty acids as primary and secondary prevention of CVD, and aims to provide a comprehensive overview of fish oil supplements on risk for CVD, and Omega-3 Index as a tool to identify subjects at high risk as well as a treatment target in CVD prevention.

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EPA’s pleiotropic mechanisms of action: a narrative review

Cited by 26 publications

References 160 publications

Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage

Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage

Mechanisms Underlying Antiarrhythmic Properties of Cardioprotective Agents Impacting Inflammation and Oxidative Stress

Is Omega-3 Index necessary for fish oil supplements for CVD risk prevention?

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