Can n-3 fatty acids provide myocardial protection by decreasing infarct size and inhibiting atherothrombosis?

Objective To present our published and unpublished data on the role of n-3 fatty acids and coenzyme Q10, a potent antioxidant and ATP-sparing agent, in decreasing myocardial infarct size and inhibiting the development of experimental atherosclerosis. Design and settings Various randomized controlled intervention trials of n-3 fatty acid rich diet, fish oil, mustard oil and coenzyme Q10 in patients with acute myocardial infarction (AMI) and human experimental studies conducted in a primary and secondary care centre in India. Randomized experiments in animals on the role of the above substances on atherosclerosis. Results In the Indian Experiment study, intake of n-3 fatty acids was significantly higher in the n-3 fatty acid rich diet intervention group (n=204) from a few days to 1 year after, compared with the control group (n=202). Lactate dehydrogenase level increased less in the intervention group than in the control group. Total cardiac events, including fatal and non-fatal myocardial infarctions as well as sudden cardiac deaths, were significantly lower in the intervention group than in the control group. Two other randomized, controlled trials in patients with AMI revealed that fish oil and mustard oil treatments were associated with a significant reduction in cardiac events compared with the respective control groups. n-3 Fatty acids, in addition, significantly decreased infarct size, incidence of heart enlargement and arrhythmias. The use of an electrocardiographic score in both fish oil and placebo groups revealed that a low score was associated with a small size of infarct, a moderate score with a medium size of infarct, and high score with a large size of infarct. Incidence of heart enlargement, arrhythmias and total cardiac events were significantly more common in patients with moderate and large infarcts compared with small ones. Treatment with fish oil plus coenzyme Q10 seemed to provide additional beneficial effects to those obtained with fish oil alone, by reducing the rise of cardiac enzymes during AMI as well as the level of pro-inflammatory markers of risk. Both n-3 fatty acids and coenzyme Q10 administration decreased the degree of experimental atherosclerosis in animals. Conclusion Fish oil and coenzyme Q10 may independently decrease infarct size, stabilize atherosclerosic plaques and inhibit experimental atherosclerosis. More studies are necessary to confirm these results.