From red candy hearts to red roses by the dozen and from gooey sentimental greeting cards to heart-felt wedding proposals, there’s plenty to remind us that February anchors the holiday for lovers, Valentine’s Day. And as that heart-pumping holiday raises the stakes on romance, let’s not forget that it’s the entire month of February that’s dedicated to the science of the heart and the ways to keep your ticker healthy.
Yes, February is American Heart Month.
This year marks the 57th consecutive year that American Heart Month will serve to raise awareness about the No. 1 killer of Americans—heart disease. Importantly, health organizations, bloggers, the news media, even U.S. presidents, have declared this month one to focus on the importance of what it means to be heart healthy, to call for more scientific research, and to educate our family and friends about leading healthier lives.
How Did the Focus on a Healthy Heart Get Started?
It was President Lyndon B. Johnson back in 1964 who got this healthy heart train moving by establishing American Heart Month with his Presidential Proclamation that has since been reinforced annually by U.S. presidents. President Johnson, who himself had suffered heart attacks, is credited with heeding Congress’ call for this annual proclamation, which is now seen by many as a turning point in this country’s broadened approach and strengthened commitment to addressing cardiovascular disease.
As the American Heart Association (AHA), one of the leading organizations promoting the cause of American Heart Month, reminds us, heart disease, in many if not most cases, is preventable by adopting a healthy lifestyle. And in the present day, AHA is joined by the American College of Cardiology, the National Institutes of Health, the Centers for Disease Control, and countless other educational, for-profit and non-profit, and governmental organizations to continue the important work of educating the public with practical tips and smart advice for reducing the risk of a heart attack, stroke, and other vascular diseases.
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At OmegaQuant, we’re proud to support these efforts, not only because omega-3s EPA and DHA have a role to play in heart health, but because when steps can be taken to improve your health, as an organization dedicated to scientific research and living healthier lives, we’re here to participate.
Let’s start with some general advice about heart health. You’ve likely seen these tips before, but during February, we hope you’ll recommit to taking them seriously. Here are five lifestyle changes you can make that should keep your heart in the pink.
- Don’t smoke.
- Maintain a healthy weight.
- Control your blood sugar, cholesterol, and blood pressure.
- Engage in regular exercise and physical activity.
- Get regular check-ups with your doctor and other healthcare practitioners.
Later in this blog, we’ll share some additional things you can do to help spread the word about American Heart Month, thereby making a difference in not only your own life, but in the lives of others.
Are Omega-3 Fatty Acids Heart Healthy?
Before we answer that question, let’s look into the role of omega-3s EPA and DHA in heart health.
Omega-3s have one of the richest bodies of scientific research when it comes to studying nutrients. These days the science goes beyond heart health, with potential benefits for the popular polyunsaturated fatty acids cited for cognitive health, mental health, athletes, pregnant women and their developing fetuses, and other conditions and populations. One recent study even suggests that those with a high Omega-3 Index (O3I) may be 75% less likely to die from COVID-19.
But if we examine the science that is truly responsible for putting omega-3s EPA and DHA on the medical and scientific map, it all begins with two Danish investigators, Jorn Dyerberg and Hans Bang, and their curiosity concerning the Greenland Eskimos, their diets, and what that meant for heart health. (Fun fact: Greenland is actually an autonomous country that is part of the Kingdom of Denmark.)
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What was interesting to the researchers at the time was that the rate of acute myocardial infarction in Eskimos was much lower than it was in Danes of matching age and sex. However, it didn’t make any sense in the world of the 1970s because the Eskimos were eating a very high saturated fat, high cholesterol diet, that of course was also very low in fruits, vegetables and fiber—stuff that was supposed to be good for you. So, it was somewhat contradictory to the typical low fat, low cholesterol diet recommended for heart protection at the time.
The researchers set out to discover clues to the Eskimos’ heart health, looking at the classic risk factors like lipid profiles, cholesterol and triglyceride levels. There they found little difference between the Greenland Eskimos and the Danes. Triglycerides were a little bit lower in the Eskimos, but there wasn’t any huge signal there either.
They also measured the plasma fatty acid profile between the two groups, and this is where things got very interesting. The Greenland Eskimos’ fatty acid profile was very rich in EPA and DHA. The EPA levels in Greenland Eskimos were seven times higher, and their DHA levels were four times higher, than the Danish Eskimos.
The Researchers Asked: Where did These EPA and DHA Molecules Come From?
To answer that question, they moved on to diet and discovered the Greenland Eskimos had a seafood-rich diet, with seal, fish and whale a traditional part of what the coastal Eskimos ate. And when Dyerberg and Bang analyzed 7-day food diaries and measured omega-3 intake, they found that EPA intake in the Eskimos was much, much higher, in the neighborhood of 2 to 2.5 grams a day, and same for DHA, around 2 grams, so roughly 4-5 grams a day of EPA and DHA–compared to <1 gram a day in the Danes’ diet.
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Now, Dyerberg had shown that omega-3 in the blood came from the diet. But still, there was no clear reason why high EPA or DHA should afford any protection. Until they did the next study, where they examined the effects of EPA, particularly, on what’s called platelet aggregation.
This part gets complicated, so we’ve actually laid it out in one of our previous blogposts if you want to understand the how’s and why’s of what they discovered about platelet aggregation.
If you’re ready for us to cut to the chase, here we go: the conclusion of all these experiments determined that EPA blocks platelet aggregation and so the reason that the Eskimos have less heart attacks is because they have higher EPA levels in their blood, because EPA strongly resists clotting. What they hypothesized was that EPA produced this unusual molecule from thromboxane A3 and prevented platelet aggregation, which prevented blood clots in the coronary arteries, and therefore heart attacks. Dyerberg and Bang felt like they had answered their questions.
They published their hypothesis in 1978 in the Lancet—that EPA could reduce risk for thrombosis and atherosclerosis. Since then, their hypothesis has been well-confirmed, and other beneficial mechanisms have been discovered as well.
How Does Omega-3 Help the Heart?
The Greenland Eskimo story is what laid the foundation (or lit the fuse) for what has turned into a huge research effort over the last 40 years, suggesting extensive benefits for omega-3s EPA and DHA. And all of it was made possible by these initial studies from Dyerberg and Bang.
Our OmegaQuant blog is chock-full of scientific studies about omega-3s. And not just the good ones. Here’s a tip: on the home page of our blog, scroll down the right-hand side and click on a category that interests you.
Now, let’s look at just a few of the studies we’ve written previously about, starting first with a new one.
New Study Suggests Higher Omega-3 Index Associated with More Rapid Heart Recovery
Published online this past November, the study researchers, led by scientists at The Cooper Institute and the Fatty Acid Research Institute (FARI), were keen to add to the literature that has suggested that omega-3s EPA and DHA can favorably impact cardiac autonomic tone, which is an important determinant of cardiovascular health and prognosis. They identified a gap in the research specifically related to omega-3 status and heart rate recovery (HRR) in healthy adults. Heart rate recovery refers to how quickly the heartbeat slows down after maximal exercise. The faster it drops, the healthier the heart.
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In other words, they wanted to know if the amount of omega-3s EPA and DHA found in red blood cells correlate to the HRR time following exercise? According to the study findings, the answer is yes.
The results were promising for omega-3s, suggesting a potential cardioprotective mechanism for the nutrients. And the results got better, the higher the Omega-3 Index.
The study population consisted of a subset selected from nearly 20,000 patients in The Cooper Center Longitudinal Study, a prospective epidemiological study of health behaviors and characters, and chronic disease biomarkers in adult men and women. Those enrolled in the original study underwent a comprehensive physical exam at The Cooper Clinic (part of The Cooper Institute) in Dallas, Texas between 2007 and 2019.
For this recent analysis, 5,128 people were excluded due to factors including prevalent cardiovascular disease or cancer (n = 1530), those with body mass index values <18.5 kg/m2 (n = 1423), those taking beta blocker medications (n = 1288), and those who failed to achieve 85% of predicted maximal heart rate during maximal treadmill exercise testing (n = 746) and two other exclusions, resulting in a study population of 13,192 healthy men and women.
Prior to giving study participants a maximal exercise test and following a 10-12 hour fast, blood was drawn and sent to OmegaQuant Analytics for analysis of the Omega-3 Index, a test that measures the amount of EPA and DHA in the blood. OmegaQuant has partnered with more than 100 institutions, universities and companies to publish groundbreaking research on the Omega-3 Index. This research continues to validate it as a marker of omega-3 status. (The Omega-3 Index is also available for use by consumers in an at-home setting.)
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Three Omega-3 Index categories were utilized for the study, identified as <4% (low), 4-8% (normal), and >8% (optimal), as well as a continuous version of this variable. Means, SDs and percentages were computed by Omega-3 Index category separately for men and women and models were also fit separately by gender.
Participants engaged in a treadmill exercise test where their HRR was determined at 1, 3, and 5 minutes of recovery. According to the study authors, when healthy people exercise, the heart rate increases with workload in a dose-response manner. Following the maximum heart rate (MHR), the fastest rate at which your heart will beat in one minute, the heart rate recovery begins in two phases—fast and slow. The fast phase occurs in the first minute of recovery.
After examining the cross-sectional associations between the Omega-3 Index and HRR, the study authors found that the Omega-3 Index was significantly and positively associated with HRR. Both men and women benefitted from a higher Omega-3 Index, with a steeper gradient in women. Each 2% increment in the Omega-3 Index was associated with a 0.31, 0.47, and 0.35 beats per minute greater adjusted HRR value in men at 1, 3 and 5 minutes, while the corresponding values for women were 0.69, 0.78, and 0.75 beats per minute.
For context, a woman with an Omega-3 Index value of 10% was found to have an estimated 3 beats per minute greater HRR at 1 minute in comparison to a woman with an Omega-3 Index of 2%.
Dr. Bill Harris, founder of OmegaQuant and the Executive Director of the Fatty Acid Research Institute (FARI) was one of the co-authors of the study.
The study authors noted some study limitations. For example, their observations were limited primarily to Caucasians, thereby limiting external validity. Further as the study was observational in nature, the associations found cannot be interpreted as causal. The authors also advised that although the results showed a significant association between a higher Omega-3 Index and a more rapid HRR that is independent of fitness, there may have been other lifestyle factors that contributed to this association, thus reverse causation cannot be entirely ruled out.
What Does Omega-3 Do for Your Heart?
While there are numerous blogs on our site that connect omega-3 dosage, and specifically advise how to determine what your Omega-3 Index is so you have a better idea about targeting your omega-3 intake, in October our blog combined that topic with heart-focused information.
For example, a study published in the September 2020 edition of the Mayo Clinic Proceedings showed that when it comes to omega-3s and heart health, more is definitely better. But how much more, only objective measures like the Omega-3 Index test can tell you.
The paper was put together in part by the Global Organization for EPA and DHA Omega-3s (GOED), who said this long-awaited meta-analysis links increases in omega-3 intake to positive cardiovascular outcomes.
The paper compiled data from the complete body of scientific evidence including ASCEND, VITAL and REDUCE-IT— and found that higher omega-3 dosages are correlated with statistically significant increases in risk reduction for a variety of cardiovascular outcomes.
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Specifically, the meta-analysis found that EPA/DHA supplementation is associated with major reductions (*statistically significant) in cardiovascular outcomes, including:
- 35% reduced risk of fatal myocardial infarction (MI)*
- 13% reduced risk of MI*
- 10% reduced risk of coronary heart disease (CHD) events*
- 9% reduced risk of CHD mortality*
- 5% reduction of cardiovascular disease (CVD) events
Importantly, the protective effect increased with dosage. An additional 1 gram/day of EPA+DHA resulted in an additional:
- 5.8% reduction in the risk of CVD events*
- 9% reduction in the risk of MI*
(Note: Study results included dosages up to 5.5 grams/day.)
To read the full blog, click here.
There’s more: Omega-3 Heart Health
In case you missed our blog last week, it’s worth taking a look, particularly if you’re confused about what role omega-3s play in raising or lowering LDL (“bad”) cholesterol levels.
Let’s recap what this blog covered in terms of heart health and omega-3s in fish oil,
namely EPA and DHA. We know those nutrients are responsible for conferring some protective benefits for the heart. But what kinds of benefits?
Specifically, studies have shown omega-3s play a role in promoting healthy blood pressure levels, reducing high triglycerides, and reducing the risk of cardiovascular disease.
Next, let’s look at how they impact cholesterol levels in general. Dr. Harris contends that omega-3s EPA and DHA do many things for the heart, but one thing they unequivocally don’t do is lower LDL cholesterol levels. That benefit is largely reserved for statins.
On the flip side of the cholesterol question, though, is whether fish oil can actually raise bad cholesterol. This is an effect that has been noted in some studies, but new research shows that fish oil has no impact on bad cholesterol levels. Read more here.
VIDEO: Discussing the STRENGTH Omega-3 Study—What Happened?
One last blog recap, before we offer some tips for changing behavior and changing minds during American Heart Month.
This blog recap is for the runners among us. In April 2019, researchers published a study looking at runners and how much they run, and then compared that to changes in their Omega-3 Index and AA/EPA ratio.
This retrospective, observational, cohort study included 257 non-elite runners who consumed no fatty acid supplements and provided a blood sample for analysis. The whole blood samples were collected by finger sticks, stored on absorbent filter paper, and then PUFAs were quantified by gas chromatography (GC) and their Omega-3 Index and AA/EPA ratio were measured.
Researchers noticed a gradual decrease of the Omega-3 Index with higher weekly running distance. At the same time, they noticed a progressive increase of the AA/EPA ratio in subjects who ran greater weekly distances. These findings suggest that distance running training and its weekly volume may negatively contribute to changes in the Omega-3 Index and AA/EPA ratio.
In particular, the data demonstrated that the level of the Omega-3 Index decreased progressively with increased weekly running distance in a dose-response manner. The observed decrease was evident at the lowest running distance and progressing in the subjects with the highest running distance. In other words, as they ran longer and harder, their Omega-3 Index went down.
These results, the study authors said, are consistent with a previously published study in athletes, which addressed a similar issue. In this study, researchers measured the Omega-3 Index in 106 German elite winter endurance athletes. They found a deficiency of EPA and DHA associated with low Omega-3 Index.
Because the population in the runner study may have an elevated risk for sudden cardiac death or for fatal and nonfatal myocardial infarction, they said a low Omega-3 Index could be considered a new risk marker and risk factor for CVD, particularly sudden cardiac death. Therefore, they believe the use of this biomarker may be a potential option to prevent cardiovascular events in athletes.
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These associations suggest that prolonged running activity may negatively influence someone’s fatty acid profile. Therefore, these study authors think future studies could assess whether regular or high intake of omega-3 rich foods may be effective to counteract the effects of running and other endurance activities on fatty acid status. Further large-scale cohort studies will be needed to confirm the influence of running activity on the Omega-3 Index and AA/EPA ratio. If you’re a runner, or love a runner, read more here.
If you want take part in February’s American Heart Month, the National Heart, Lung and Blood Institute offers 25 ways to get involved. Among those 25 ways is the suggestion to blog about it. So, we did.
During the pandemic, many of us may have put our heart health on the back burner, with stress interfering with our attempts to eat healthy, lockdowns interrupting our gym workouts, and concerns about going to see our doctors. We’re leaving you with our own five tips during American Heart Month that are not only heart friendly, but also pandemic friendly.
- Dedicate one week in February to cooking heart-healthy recipes.
- Consider adding healthy fats—like omega-3s EPA and DHA to your diet. Your heart will thank you. The American Heart Association recommends eating (fatty) fish at least twice a week to get your omega-3s. (If you don’t like fish, consider taking fish oil—or algae oil—supplements to get your omega-3s.)
- Add in an extra walk per day this month with your dog. If you don’t have a dog, how about with your spouse, your child or your neighbor. Remember to socially distance. Or take that extra walk alone and use that time to clear your head and focus on positive thinking. Everyone deserves some “me” time.
- Take five days to stick to a sleep routine. Counting sheep is so passé. But sleeping well never goes out of style. Plus, good sleep is heart helpful.
- Commit to keeping the positive changes you’ve made for your heart during American Heart Month alive throughout the year. After all, we need our hearts healthy, year-round.
VIDEO: OmegaMatters – EPISODE #1: The COVID-19 & Omega-3 Index Study