Heart attacks are a leading cause of death and disability, affecting one person in the United States every 40 seconds. The 90-day period after a heart attack has become known as a critical window when new problems, or additional heart attacks, often occur. Effective treatments to improve outcomes and prevent further cardiovascular issues are essential.

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According to the American Heart Association (AHA), more than a quarter of patients are readmitted to the hospital within 90 days of discharge. Furthermore, the AHA notes that second heart attacks during that 90-day window are linked to nearly a 50% risk of dying over the next five years. Continued treatment and risk mitigation must take priority to maintain health, avoid another heart attack, and improve chances of returning to a healthy and productive life.

 

What happens during a heart attack?

A heart attack, also known as myocardial infarction (MI), occurs when the blood flow that carries oxygen and nutrients to the heart muscle is severely reduced or cut off completely. Lack of blood, oxygen, and nutrients to the muscle cells leads to cellular damage and death. Heart attacks are, at the root, a circulation problem. While heart attacks often feel sudden, they are actually the result of the slow build-up of plaque in the blood vessels, known as atherosclerosis. Atherosclerosis develops over years but may display no symptoms until the artery is narrowed by over 70%. When blood flow restriction is severe enough to lead to heart cell damage and death, a heart attack occurs.

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The amount of damage to the heart muscle can vary among individuals depending on the size of the area injured and the time to treatment. Furthermore, proper treatment and lifestyle changes after a heart attack can limit further damage and risk for future cardiovascular concerns. Eating a heart-healthy diet is one strategy to limit the incidence of heart attacks and support recovery if one occurs. Among the nutrients of interest related to cardiovascular disease, omega-3 fatty acids have been well-studied for their cardiovascular benefits.

 

How might Omega-3s support patients who have experienced heart attacks?

The association between omega-3 intake and cardiovascular outcomes began in the 1980s with epidemiologic studies of Greenland Inuit populations, who consume large amounts of fish and experience a very low incidence of coronary heart disease. Yet, this was just the beginning.

Since then, many studies have been conducted on omega-3s and cardiovascular health, which have teased out, more specifically, which aspects are impacted and how. A 2022 meta-analysis of 14 large-scale randomized controlled studies demonstrates this by revealing the positive effects of omega-3s on major adverse cardiovascular events (MACEs), cardiovascular death, and the occurrence of MI. The authors noted that omega-3 supplementation, ranging from 0.8-1.2g, exhibited good clinical benefits for the primary and secondary prevention of coronary heart disease.

Omega-3 fats have multiple physiological effects on cardiovascular health that are explained in detail in other works. However, to review, the cardioprotective effects of omega-3s may improve outcomes by influencing known cardiovascular risk factors and playing essential and diverse roles in cellular and genetic function.

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It’s well documented that omega-3 fats lower plasma triglyceride levels by reducing lipoprotein synthesis. Omega-3 consumption can reduce resting heart rate and blood pressure, increase nitric oxide production, and affect electrophysiological pathways. Several studies have demonstrated improved endothelial function and autonomic function with omega-3 supplementation. Furthermore, omega-3s also provide anti-inflammatory effects by acting as precursors to inflammation-resolving mediators such as resolvins and protectins.

While much of the evidence today focuses on the incidence of cardiovascular disease and death related to cardiovascular events, little research has been done on omega-3 impacts after an event occurs. Cardiac remodeling, defined as molecular, cellular, and interstitial changes occurring after a cardiovascular event, can manifest as changes in size, mass, geometry, and heart function after injury.

Despite advances in medical science, adverse cardiac remodeling remains prevalent after heart attacks, leading to future cardiovascular health consequences. The OMEGA-Remodel Study aimed to fill this knowledge gap by investigating the effects of six months of Omega-3 treatment on patients after a heart attack. The researchers of this study sought to understand if any long-term health benefits and improved cardiac remodeling came from receiving omega-3 treatment.

 

OMEGA-REMODEL Study

Published in March 2024, the OMEGA-REMODEL study sought to determine whether patients who received omega-3 treatment for six months after a heart attack derived any long-term health benefits. The rationale for this trial was to provide therapeutic support during the critical phase of infarct health to improve patient outcomes.

Three hundred sixty patients from the Boston area were included in the study, which supplemented them for six months after MI and followed them for a total of 6 years. The omega-3 treatment group received 4g of omega-3s daily (~465mg EPA + ~375mg DHA), and the placebo group received 4g of corn oil daily. Response to the treatment was evaluated by measuring the Omega-3 Index at baseline and after six months. The researchers sought to determine if there was a difference in MACE between those assigned the omega-3 treatment compared to the placebo over the follow-up period and who – regardless of group assignment – experienced an increase in Omega-3 Index by at least 5% while on the treatment.

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The researchers found no long-term difference in MACE rates between the omega-3 treatment group and the placebo group. However, there was a clinically significant reduction in MACE risk in people whose Omega-3 Index increased by 5% or more (approximately 1/3 of the treated patients) compared to those who did not. These results support evidence from an earlier study, which reported that a 5% increase in the Omega-3 Index from baseline was also associated with a lower rate of cardiac arrest. Therefore, the researchers concluded that, although more research is needed to confirm the association, treatment strategies that titrate a 5% increase in the Omega-3 Index may lead to favorable post-MI outcomes.

 

OMEGA-REMODEL Lessons

The results of this study demonstrate that taking a supplement for the sake of taking a supplement may not be enough. To receive health benefits, one must supplement at a level high enough to achieve a healthy target blood level, which can vary among individuals. In this study, it is unknown why some taking the supplement experienced high enough increases in their Omega-3 Index while others did not. Compliance, method, or other genetic factors predispose a person to better absorption and utilization of omega-3s. Regardless, raising the Omega-3 Index reduces the long-term risk for MACE after an MI.

Potentially even more important, this study suggests that one reason for conflicting results of past Omega-3 studies could be that the Omega-3 Index was not measured or raised sufficiently to affect clinical change or impact health outcomes. It also indicates that people may benefit more from individualizing their approach to omega-3 supplementation, focusing on achieving a healthy omega-3 index rather than simply taking a supplement.

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Furthermore, the results suggest differences among individuals in how they respond to omega-3 treatment. New studies are needed to understand this deeper, so people can better understand their unique omega-3 needs. The results of this study can provide valuable insights into the potential benefits of Omega-3 for heart attack survivors and their long-term recovery.

 

Summary

Current evidence indicates that increasing Omega-3 Index levels may support cardiovascular health before and after cardiovascular events. Increasing omega-3 intake through seafood consumption and supplementation are excellent practices. However, as evidence evolves, it’s becoming clear that omega-3 support cannot be a one-size-fits-all approach and will only provide positive health impacts if you consume them in high enough quantities to achieve a healthy Omega-3 Index. Yet, with unknown variables influencing a person’s ability to utilize omega-3s, assessing individual levels is the best way to determine adequate intake. So instead of asking, “How much omega-3s do I need daily?” we should ask, “What’s my Omega-3 Index?”

These statements have not been evaluated by the Food and Drug Administration. This test is not intended to diagnose, treat, cure, prevent or mitigate any disease. This site does not offer medical advice, and nothing contained herein is intended to establish a doctor/patient relationship. OmegaQuant, LLC is regulated under the Clinical Laboratory improvement Amendments of 1988 (CLIA) and is qualified to perform high complexity clinical testing. The performance characteristics of this test were determined by OmegaQuant, LLC. It has not been cleared or approved by the U.S. Food and Drug Administration.

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