SEDICO Newsletter Volume 7 Omega-3 Fatty Acids & Statins

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1 Omega-3 fatty acids on heart function (including anti-arrhythmic effects), hemo-dynamics (cardiac mechanics) and arterial endothelial function. The link between omega-3 fatty acids and CVD risk reduction are still being studied, but research has shown that omega-3 fatty acids: Decrease risk of arrhythmias, which can lead to sudden cardiac death Decrease triglyceride levels Decrease growth rate of atherosclerotic plaque Lower blood pressure (slightly) Omega-3 fatty acids benefit the heart of healthy people, and those at high risk of - or who have - cardiovascular disease.

2 What do epidemiological and observational studies show? Epidemiologic and clinical trials have shown that omega-3 fatty acids reduce CVD incidence. Large-scale epidemiologic studies suggest that people at risk for coronary heart disease benefit from consuming omega-3 fatty acids from plants and marine sources. Increasing omega-3 fatty acid intake through foods is preferable. However, coronary artery disease patients may not be able to get enough omega-3 by diet alone. These people may want to talk to their doctor about taking a supplement. Supplements also could help people with high triglycerides, who need even larger doses. The availability of high-quality omega-3 fatty acid supplements, free of contaminants, is an important prerequisite to their use. Can Omega 3 plus capsules be used with the blood lowering cholesterol drugs? The Omega 3 plus capsules are the safest combination with Statins (Lipona tablets) What is the recommended dose for Omega 3 plus capsules? Omega 3 F.A. recommendations by the American Heart Association (AHA) is 1 gram of EPA & DHA daily, i.e. one capsule three(3) times daily. Patients without documented coronary heart disease (CHD) : Eat a variety of (preferably fatty) fish at least twice a week. Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts). Patients with documented CHD : Consume about 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA in capsule form could be considered in consultation with the physician.

3 Patients who need to lower triglycerides: 2 to 4 grams of EPA+DHA per day provided as capsules under a physician s care. Patients taking more than 3 grams of omega-3 fatty acids from capsules should do so only under a physician s care. High intakes could cause excessive bleeding in some people. Does Omega 3 plus capsules essential for pregnancy? Omega 3 plus capsules as important as folic acid for optimizing early fetal development and preventing neural tube defects. The recommended daily dose during pregnancy is 300 mg. Also the Omega 3 fatty acids decrease risk of premature birth. The daily dose for: Maintenance & protection is one capsule. Preterm delivery is 3 (three) capsules daily Children can use omega 3 plus capsules? Omega 3 plus capsules is useful for children increases intelligence of child at the age of 4. What are the benefit using the Omega 3 plus capsules? The Omega 3 plus capsules is the key : Reduce triglyceride level maintains healthy blood vessels Reduce the risk of ischemic heart disease Improves pregnancy performance As anti-thrombotic & anti-atherosclerotic Reduces incidence of prematurely Essential for brain and retinal development

4 "Statins" (or HMG-CoA reductase inhibitors) are a class of drugs that lower cholesterol levels in people with or at risk of cardiovascular disease. What are Statins, and how do they work? They lower cholesterol by inhibiting the enzyme hydroxy-methylglutarylcoenzyme A reductase (HMG-CoA reductase), which is the rate-limiting enzyme of the mevalonate pathway of cholesterol synthesis. Inhibition of this enzyme in the liver results in decreased cholesterol synthesis as well as increased synthesis of LDL receptors, resulting in an increased clearance of low-density lipoprotein (LDL) from the bloodstream. The first results can be seen after one week of use and the effect is maximal after four to six weeks.

5 Cholesterol is critical to the normal function of every cell in the body. However, it also contributes to the development of atherosclerosis, a condition in which cholesterol-containing plaques form within arteries. These plaques block the arteries and reduce the flow of blood to the tissues that arteries supply. When plaques rupture, a blood clot forms on the plaque, thereby further blocking the artery and reducing the flow of blood. When blood flow is reduced sufficiently in the arteries that supply blood to the heart, the result is angina (chest pain) or a heart attack. If the clot occurs on plaques in the brain, the result is a stroke. If the clots occur on plaques in the leg, they cause intermittent claudication (pain in the legs while walking). By reducing the production of cholesterol, Statins are able to slow the formation of new plaques and occasionally can reduce the size of plaques that already exist. In addition, through mechanisms that are not well understood, Statins may also stabilize plaques and make them less prone to rupturing and promoting the development of clots.

6 The important role of cholesterol in atherosclerosis is widely accepted by scientists. Research from the last few years shows that aggressive cholesterol reduction is more beneficial than modest reductions. The scientists have also discovered that inflammation in the walls of the arteries may be an important factor in atherosclerosis. In addition to lowering cholesterol levels, Statins also reduce inflammation, which could be another mechanism by which Statins beneficially affect atherosclerosis. This reduction of inflammation does not depend on Statins ability to reduce cholesterol. Furthermore, these anti-inflammatory effects can be seen as early as two weeks after starting Statins. For what conditions are Statins used? Statins are used for preventing and treating atherosclerosis that causes chest pain, heart attacks, strokes, and intermittent claudication in individuals who have/are at risk for atherosclerosis. Risk factors for atherosclerosis include: Abnormally elevated cholesterol levels A family history of heart attacks (particularly at a young age) Increasing age Diabetes The goal of treatment with Statins should not be only the reduction of cholesterol to normal levels, but rather the prevention of the complications of atherosclerosis (angina, heart attacks, stroke, intermittent claudication, and death). This concept is important because it allows for individuals who have or are at risk for atherosclerosis, but do not have high levels of cholesterol, to be considered for treatment with Statins.

7 Increasing LDL uptake Liver cells sense the reduced levels of liver cholesterol and seek to compensate by synthesizing LDL receptors to draw cholesterol out of the circulation.this is accomplished via protease enzymes that cleave a protein called "membranebound sterol regulatory element binding protein", which migrates to the nucleus and causes increased production of various other proteins and enzymes, including the LDL receptor. The LDL receptor then relocates to the liver cell membrane and binds to passing LDL and VLDL particles (the "bad cholesterol" linked to disease). LDL and VLDL are drawn out of circulation into the liver and are digested. Does Statins has other effects? Statins exhibit action beyond lipid-lowering activity in the prevention of atherosclerosis. The ASTEROID trial showed direct ultrasound evidence of atheroma (is an accumulation and swelling (-oma) in artery walls that is made up of cells (mostly macrophage cells), or cell debris, that contain lipids cholesterol and fatty acids) regression during Statins therapy. Researchers hypothesize that Statins prevent cardiovascular disease via four proposed mechanisms (all subjects of a large body of biomedical research): Improve endothelial function Maintain plaque stability Modulate inflammatory responses Prevent thrombus formation Statins may even benefit those without high cholesterol. In 2008 the JUPITER study showed fewer stroke, heart attacks, and surgeries even for patients who had no history of high cholesterol or heart disease, but only elevated C-reactive protein levels. There were also 20% less deaths (mainly from reduction in cancer deaths) though deaths from cardiovascular causes were not reduced. Statins have been linked to a marked reduction in prostate cancer, benign prostate enlargement, incontinence and impotence in older men.

8 What are the indications and uses of Statins? Statins, the most potent cholesterol-lowering agents available, lower LDL cholesterol (so-called "bad cholesterol") by 1.8 mmol/l. This translates in a 60% decrease in the number of cardiac events (heart attack, sudden cardiac death), and a 17% reduced risk of stroke. They have less effect than the fibrates or niacin in reducing triglycerides and raising HDL-cholesterol ("good cholesterol"). Professional guidelines generally require that the patient has tried a cholesterollowering diet before Statins use is considered; Statins or other pharmacologic agents may then be recommended for patients who do not meet their lipid-lowering goals through diet and lifestyle approaches. As with other Statins, Atorvastatin (Lipona) is a competitive inhibitor of HMG- CoA reductase. Unlike most others, however, it is a completely synthetic compound. HMG-CoA reductase catalyzes the reduction of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) to mevalonate, which is the rate-limiting step in hepatic cholesterol biosynthesis. Inhibition of the enzyme decreases de novo cholesterol synthesis, increasing expression of low-density lipoprotein receptors (LDL receptors) on hepatocytes. This increases LDL uptake by the hepatocytes, decreasing the amount of LDLcholesterol in the blood. Like other Statins, Atorvastatin also reduces blood levels of triglycerides and slightly increases levels of HDL-cholesterol. we wish you always been in a good health

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