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Reduction of Cardiovascular Risk Factors with Longterm Fish Oil Treatment in Early Rheumatoid Arthritis
LESLIE G. CLELAND, GILLIAN E. CAUGHEY, MICHAEL J. JAMES, and SUSANNA M. PROUDMAN ABSTRACT. Objective. Rheumatoid arthritis (RA) is associated with increased risk for cardiovascular (CV) events through multiple factors. Fish oil has been shown to reduce symptoms in RA and to reduce CV risk. We assessed the effect of an antiinflammatory dose of fish oil on CV risk factors within a program of combination chemotherapy for patients with early RA. Methods. Patients who chose not to take fish oil (n = 13) were compared with patients who achieved a sustained elevation of eicosapentaenoic acid (EPA) in plasma phospholipid fatty acids (> 5% total fatty acids) while taking fish oil over a 3-year period (n = 18). We examined cellular content of arachidonic acid (AA), synthesis of thromboxane A2 and prostaglandin E2, use of nonsteroidal antiinflammatory drugs (NSAID), traditional CV lipid risk factors, and disease activity at 3 years. Results. At 3 years, AA (as a proportion of AA plus long-chain n-3 fatty acids that can compete with AA for cyclooxygenase metabolism) was 30% lower in platelets and 40% lower in peripheral blood mononuclear cells in subjects taking fish oil. Serum thromboxane B2 was 35% lower and lipopolysaccharide-stimulated whole-blood prostaglandin E2 was 41% lower with fish oil ingestion compared to no fish oil. NSAID use was reduced by 75% from baseline with fish oil (p < 0.05) and by 37% without fish oil (NS). Favorable changes in fasting blood lipids were seen with, but not without fish oil. Remission at 3 years was more frequent with fish oil use (72%) compared to no fish oil (31%). Conclusion. Fish oil reduces cardiovascular risk in patients with RA through multiple mechanisms. (First Release Aug 1 2006; J Rheumatol 2006;33:1973-9) Key Indexing Terms:
FISH OIL From the Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia. Supported by the National Health and Medical Research Council of Australia. Berg LipidTech, Aalesund, Norway, provided a proportion of the fish oil used in the study. L.G. Cleland, MD, FRACP, Director of Rheumatology; G.E. Caughey, PhD, Research Officer; M.J. James, PhD, Chief Medical Scientist; S.M. Proudman, MB BS, FRACP, Senior Visiting Rheumatologist. Address reprint requests to Prof. L.G. Cleland, Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia 5000. E-mail: lcleland@mail.rah.sa.gov.au Accepted for publication April 11, 2006.
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