October 2009
The Confidential Newsletter of the Track Your Plaque Program 
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The omega-3 index: Shedding new light on cardiac risk

So you take a few fish oil capsules every day. You try to eat fish once or twice a week. But is that enough to take full advantage of the heart health benefits of omega-3 fatty acids? Is it enough to maximally reduce risk for heart attack and other cardiovascular events?

If you take fish oil capsules, what is the concentration of omega-3 fatty acids? How well are they absorbed? How effectively are the omega-3 fatty acids you absorb incorporated into cell membranes?

Even if you take fish oil capsules, can you be sure that the amount of omega-3 fatty acids in your blood and tissues is at an optimum level?

It is now possible to measure the amount of omega-3 fatty acids in your bloodstream and confidently know just how much you have. Too little and you might still be at high risk for cardiovascular events.

Omega-3 levels and sudden cardiac death

Two large studies, one from the University of Washington study and the other from Boston, demonstrated that higher omega-3 blood (the level in red blood cells, or RBCs) levels were associated with reduced likelihood of sudden cardiac death:

Harris WS 2008; adapted from Siscovick DS et al 1995 and Albert CM et al 2002
The omega-3 Index was derived from whole blood omega-3 levels,
which correlate with RBC omega-3 levels, and are thus “estimated.”

From the graph, you can see that the risk for sudden cardiac death is 10-fold higher for the lowest omega-3 RBC levels compared to the highest.

What’s the average omega-3 RBC level for Americans? Most Americans have omega-3 RBC levels in the 2.5-4.0% range. People with heart disease can have levels less than 1%.

Subsequent studies have shown that the proportion of omega-3 fatty acids, or the omega-3 index, has greater power to discriminate who will have a heart attack or die from sudden cardiac death better than any other common laboratory measure of coronary risk, including LDL cholesterol, HDL cholesterol, triglycerides, total cholesterol to HDL ratio, homocysteine, and c-reactive protein.

Beyond the heart attack- and sudden cardiac death-reducing effects demonstrated in studies like the 11,000-participant GISSI Prevenzione Study, omega-3 fatty acids modify the properties of cell membranes, including those in heart muscle. Omega-3 fatty acids stabilize heart rhythm generation, thus the decreased abnormal heart rhythms observed in both experimental preparations and humans. When omega-6s are released from cell membranes by the action of the enzyme, phospholipase A2, inflammatory eicosanoids like thromboxane are released. When omega-3s are released instead, a cascade of anti-inflammatory eicosanoids like prostacyclin are produced, along with beneficial action on nuclear receptors that yield improved lipid metabolism. This results in reduced triglycerides, reduced blood pressure, improved endothelial responsiveness, and more stable plaque.

What does the omega-3 index tell you? Just as hemoglobin A1c offers a 3-month look into blood glucose levels, the omega-3 index reflects your long-term omega-3 intake. The quantity of RBC omega-3s also closely parallels the quantity of omega-3s in heart tissues.

What is an ideal omega-3 index?

The above curves relating RBC omega-3 levels and sudden cardiac death suggest that a level of 6.3-7.3% is associated with far fewer fatal events - but events are not eliminated at this level. Is there even greater benefit with levels higher than 6.3-7.3%?

A recent analysis of females from the Harvard School of Public Health suggested that RBC omega-3 levels as high as 8.99% were still associated with non-fatal heart attack (myocardial infarction), compared to 9.36% in those without heart attacks. This suggests that even higher levels are necessary to prevent non-fatal events (Sun 2008).

What’s your omega-3 index?

The appreciation of the importance of omega-3 fatty acids marks one of the greatest health revelations of the last 50 years. We can now quantify it.

The ability to measure the proportion of omega-3 fatty acids in red blood cells may provide yet another means for all of us to further reduce plaque growth and risk for cardiovascular events.

Should you choose to have your RBC omega-3 index measured, please be sure to report your experience back to us through The Heart Scan Blog  or through the Forums on www.trackyourplaque.com.

Copyright 2009 Track Your Plaque, LLC

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