The potential mechanisms of action of omega-3 acids in coronary heart disease risk reduction are based on their anti-arrhythmic, anticoagulant, anti-inflammatory, vascular endothelial function-improving, and hypotensive and triglyceride level-reducing properties. Docosahexaenoic acid, (DHA) originating from fish and fish fat acts, above all, on lipids and lipoproteins, blood pressure, heart rate and glycaemia, and eicosapentaenoic acid (EPA) is primarily responsible for the anti-aggregative actions. The effect of omega-3 acids on triglyceride serum level lowering is well documented in numerous studies (lowering by 25 to 30%). The effect of omega-3 acids on the postprandial triglyceride level is depends more on their chronic intake, even at lower doses, than on large single doses. The cardioprotective effect of omega-3 acids is obtained at much lower doses (ca. 1g/day) which can be covered by dietary sources. The strength of action of omega-3 acids especially in secondary prevention of coronary heart disease is based on their anticoagulant action. Omega-3 acids were shown to reduce blood platelet aggregation, which leads to prolonged bleeding time. In some studies supplementation of omega-3 acids was found to result in increased fibrynolysis. Nevertheless, as demonstrated by the CARDIA study, the supply of omega-3 acids was negatively correlated with the levels of fibrinogen, factor VII, and von Willebrand factor, with no significant effect on these parameters with habitual dietary supply of marine fish or omega-3 acids. A beneficial action of omega-3 acids is their lowering effect on blood pressure. Systematic supply of both omega-3 acids was shown to contribute to systolic and diastolic pressure reduction in hypertensive as well as in normotensive persons. Both omega-3 acids, DHA and EPA, have been attributed a role in reducing the risk of sudden cardiac death for years. This is suggested as being possible owing to their anti-arrhythmic action. The adequate intake of these both acids (at least one meal a week) was found to stabilise the myocardium, causing accelerated heart rate in patients with a history of myocardial infarction, which results in reduced risk of mortality due to cardiac arrhythmia. Furthermore, both acids were found to reduce the heart rate at rest, increasing the left ventricular filling volume. The mechanism of anti-arrhythmic action of both acids is based on stimulation of calcium channel activity to prevent calcium overload in the period of stress, stimulation of activity of microsomal Ca²/Mg² ATP-ase and inhibition of sodium channel voltage in cardiac myocytes, which is also affected by a-linolenic acid. Omega-3 acids are prostaglandin and leukotriene precursors, being at the same time cytokine and mitogen synthesis inhibitors. They stimulate endothelial nitrogen oxide, owing to which they also counteract oxidative processes. Therefore, their adequate dietary supply ensures anti-inflammatory effects.

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