Chronic heart failure (CHF) is a common condition, which despite major
advances, is still characterized by high mortality (with sudden arrhythmic
death a particular risk), poor quality of life due to exercise intolerance
and frequent hospitalizations. Epidemiological studies suggest that
populations with a high intake of marine polyunsaturated fatty acids
(PUFAs or fish oils) have low levels of cardiovascular mortality.
Animal and human studies of fish oil supplementation have demonstrated
improved endothelial function and myocardial relaxation, reduced
vascular tone and platelet aggregability, and a stabilization of
myocyte excitability by prolongation of the refractory period. Marine
PUFAs also have potentially important immune-modulating effects,
reducing cytokine production and release, and altering prostaglandin
metabolism. Data from patients following acute myocardial infarction
have suggested that marine PUFA supplementation may reduce early
mortality, mostly by reducing the risk of sudden arrhythmic death.
Until recently, data in patients with chronic heart failure was lacking,
but the recent publication of the GISSI-HF study, randomizing more
than 7000 CHF patients to marine PUFA supplementation or placebo
has clarified somewhat the role of these agents. The aim of this
article is to review the theoretical benefits of marine PUFAs and
to discuss the implications of the GISSI-HF study for the management
of patients with CHF.
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