Benefit–Risk Assessment of Fish Oil in Preventing

Authors: Bill Lands

Publish Date: 2016/07/13

Volume: 39, Issue: 9, Pages: 787-799

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Abstract

Cardiovascular disease CVD is a preventable disease which combines two general processes chronic vascular inflammation and acute thrombosis Both are amplified with positive feedback signals by n6 eicosanoids derived from foodbased n6 highly unsaturated fatty acids n6 HUFA This amplification is lessened by competing actions of n3 HUFA Death results from fatal interactions of the vascular wall with platelets and clotting proteins The benefits of fish oil interventions are confounded by complex details in pharmacokinetics pharmacodynamics adverse events timescale factors topology financial incentives and people’s sense of cause and effect Two basic aspects of n3 HUFA that are overlooked in CVD dynamics are saturable hyperbolic responses of the enzymes continually supplying n6 HUFA and hardtocontrol positive feedback receptor signals by excessive n6 HUFA–based mediators Multiple feedback loops in inflammation and thrombosis have diverse mediators and reducing one mediator that occurs above its ratelimiting levels may not reduce the pathophysiology Clinicians have developed some successful interventions that decrease CVD deaths in the form of secondary prevention However the current high CVD prevalence in the USA remains unchanged and successful primary prevention of CVD remains uncertain This review weighs the available evidence to help clinicians the biomedical community and the public put the use of fish oil supplements into a balanced perspectivePerseverance and rigorous logic are needed to integrate the many CVD concepts into multicompartment models that correctly represent the complex reality that occurs when a person ingests n3 and n6 nutrients Oversimplified monocompartment and twocompartment models are often used to interpret clinical trials of patented medications However the complexity is much greater for n3 nutrient actions than for most medications Dietary essential n3 fatty acids act continually in the presence of abundant competing n6 homologues and both n3 and n6 highly unsaturated fatty acids HUFA form important bioactive mediators This review weighs the available evidence to help clinicians the biomedical community and the public put the use of fish oils into a balanced perspective

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