Omega-3 treatment was associated with significantly fewer gastrointestinal bleeding events for patients with left ventricular assist devices (LVADs), researchers reported in Circulation: Heart Failure.
The study population consisted of 166 patients implanted with an LVAD at the University of Chicago Medical Center between April 2014 and May 2017. Thirty of them received 4 milligrams per day of omega-3 treatment in addition to routine care, while the rest received guideline-directed medical therapy alone.
One patient (3 percent) in the omega-3 group experienced gastrointestinal bleeding (GIB) within one year, while 30 patients (22 percent) in the control group had GI bleeds. Upon multivariable analysis, omega-3 therapy was associated with an 87 percent reduction in the risk of GIB. Age was the only other factor independently associated with GIB, with a 51 percent risk increase per 10-year bump in age.
Senior study author Nir Uriel, MD, MSc, and colleagues speculated the anti-inflammatory and antiangiogenic properties of omega-3—a fatty acid commonly found in fish—played a role in the risk reduction. They noted a registry study of LVAD recipients in Japan showed similarly low rates of GIB as the omega-3 patients in this study, and said that correlation could be due to Japan’s fish-rich diet.
“Further studies that compare angiogenesis-related biomarkers and GIB rates in patients receiving a same device (ie, HeartMate II) between United States and Japan are warranted,” the researchers wrote.
Uriel et al.’s previous work suggested a link between arteriovenous malformations (AVMs) and the development of GIB in LVAD patients—an outcome that has been reported in 15 percent of LVAD recipients at six months and in 35 percent at two years.
“The omega-3 therapy was associated with the reduced GIB rate, which may strengthen our hypothesis that the major cause of GIB in LVAD patients is the development of AVM via angiogenesis-related cascade instead of anticoagulation and antiplatelet therapies,” they wrote. “The mechanism of action of omega-3 may be related to reductions in (tumor necrotic factor) TNF-α, with subsequent suppression of angiopoietin-2 expression, although nobody has any direct pieces of evidence for their relationship.”
Limitations of the study included its small sample size and nonrandomized, observational design. Given these considerations, Uriel and coauthors said their work should be interpreted as “proof of concept” only, with an additional need for randomized controlled studies.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.