February is well known as the month for love, with Valentine’s Day just around the corner. It is also a good time to reflect on our heart health, given it is “Heart Month.”
 
This past November, the American Heart Association (AHA) released its updated heart disease and stroke prevention guidelines. Its dietary advice: “Recommended are dietary patterns that emphasize fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts. Red meat and sugary foods and beverages should be limited … The overall dietary pattern should include less sodium.”
 
The advice to eat more fish is borne out of thousands of studies supporting the importance of EPA/DHA omega-3 fatty acids (from fish) for cardiovascular health. Many authoritative groups, including the AHA, advise eating at least two fish meals/week (preferably oily fish) in order to reduce risk of cardiovascular disease. 
 
Population studies, mostly relying on self-reported intakes, have consistently found omega-3 intakes reduce risk of CHD death (Mozaffarian & Wu, 2011). Results of randomized controlled trials (RCTs) of omega-3 supplementation and CHD death have been mixed, attributed in part to the use of subjects with established CHD, which limits the application of the results to the general, healthy population (Rizos et al, 2012).  Mozaffarian and others (2013) conducted a prospective cohort study to examine omega-3 fatty acid levels in blood and resulting total and cause-specific mortality among healthy older adults not taking omega-3 supplements. Those with the highest levels of total n3-PUFA experienced a 48% reduction in risk of CHD death, compared to those with the lowest levels.  
 
So, what do these blood levels mean in terms of diet? The researchers note their findings support average target intakes in the range of 250-400 mg EPA+DHA daily, which is achievable with the two fatty fish meals per week recommended by the AHA, Dietary Guidelines for Americans (2010), American and Canadian Dietitians’ Associations (2014) and consistent with intakes recommended by ISSFAL (2004), and other international expert organizations. 
 
A Big Burden
Although rates of heart disease have declined, due to the medical advances of recent decades, the Heart Disease and Stroke Statistics for 2014 (published by the AHA) are a reminder that the burden of CVD remains staggering. It continues to account for one in three deaths in the U.S., and is the most costly of all diseases, with 2010 estimated costs of CVD and stroke of $315.4 billion. 
 
Poor dietary habits continue to play an important role, contributing more than 13% to total CVD death (high blood pressure: 40.6%; smoking: 13.7%; low physical activity: 11.9%). A 2009-10 estimate showed less than 1% of Americans met four out of five healthy dietary goals, and less than one in five (18.3%) met the goal of two fish meals weekly.
 
The Academy of Nutrition & Dietetics (2014), together with Dietitians of Canada have recently updated their position statement on fat intake, stating “Healthy adults should consume between 20 percent and 35 percent of their calories from dietary fat, increase their consumption of omega-3 fatty acids, and limit their intake of saturated and trans fats.”
 
Are you getting your minimum two fish meals weekly? The research shows you can reduce your risk of heart disease with this simple lifestyle measure. If this remains an obstacle, ask your registered dietitian about an EPA/DHA omega-3 supplement or fortified foods to ensure you are getting enough of these vital nutrients. Give your heart a little love!

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Citations
Mozaffarian, D. and J. H. Wu (2011). “Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events.” J Am Coll Cardiol 58 (20): 2047-2067.
 
Rizos, E. C., E. E. Ntzani, E. Bika, M. S. Kostapanos and M. S. Elisaf (2012). “Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis.” JAMA 308 (10): 1024-1033. 
 
Mozaffarian D Lemaitre RN King IB Song X Huang H Sacks FM Rimm EB Wang M and Siscovick DS (2013). Plasma Phospholipid Long-Chain ω-3 Fatty Acids and Total and Cause-Specific Mortality in Older Adults: A Cohort Study. Ann Intern Med 158:515-525.