Recent research showed 82% of 233 retired National Football League players under age 50 had abnormal narrowing and blockages in arteries compared to the general population of the same age. It has been suggested that early screening and intervention in this at-risk population be a priority.
Hypothesis:
Omega-3 essential fatty acid has been shown to improve cardiovascular lipid risk factors and should improve lipid profiles in professional football players to help reduce their recently shown accelerated risk of developing cardiovascular disease.
Methods:
A total of 36 active national football players were randomly assigned to 2 groups: the first group (n = 20) was provided fish oil capsules (2200 mg of mixed docosahexaenoic acid and eicosapentaenoic acid and 360 mg of other omega-3s), and the second group (n = 16) served as controls during a 60-day trial. Vertical Auto Profile cholesterol tests directly measuring serum low-density lipoprotein, high-density lipoprotein, and other subfractions were performed. Compliance, side effects, and seafood consumption data were also collected. Baseline, midpoint, and poststudy blood work measured plasma docosahexaenoic acid and eicosapentaenoic acid.
Results:
Treatment increased high-density lipoprotein (average percent change: +25.96, control +14.16), decreased triglycerides treatment (–8.06, control +43.98), very low-density lipoprotein treatment (–13.98, control +23.18), intermediate density lipoprotein (–27.58, control +12.07), remnant lipoproteins (–23.86, control +8.33), and very low-density lipoprotein-3 (–17.10, control +7.77). An average increase of 106.67% for docosahexaenoic acid and 365.82% for eicosapentaenoic acid compared to control was also shown.
Conclusion:
Omega-3 supplementation significantly improved the lipid profile of active players randomized to treatment. These results suggest that fish oil supplementation is an effective way to increase eicosapentaenoic acid and docosahexaenoic acid levels in plasma and should be considered as a method to improve modifiable cardiovascular risk lipid factors in professional football players.
Clinical Relevance:
A prospective study examining the effects of 60 days of a highly purified fish oil supplementation in professional football players.
AustinMAHokansonJEBrunzellJD. Characterization of low-density lipoprotein subclasses: methodologic approaches and clinical relevance. Curr Opin Lipidol. 1994;5:395–403.
3.
AustinMAKingMCVranizanKMKraussRM. Atherogenic lipoprotein phenotype. A proposed genetic marker for coronary heart disease risk. Circulation. 1990;82:495–506.
4.
BellostaSPaolettiRCorsiniA. Safety of statins focus on clinical pharmacokinetics and drug interactions. Circulation. 2004;109:III-50–III-57.
5.
BrownBGZhaoXQChaitA. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. 2001;345:1583–1592.
6.
BucherHCHengstlerPSchindlerCMeierG. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med. 2002;112:298–304.
7.
CalabresiLDonatiDPazzucconiFSirtoriCRFranceschiniG. Omacor in familial combined hyperlipidemia: effects on lipids and low subclasses. Atherosclerosis. 2000;1482387–396.
8.
CallahanLFCurreySSJonasBL. Osteoarthritis in retired national football league (NFL) players: the role of injuries and playing position. Arthritis Rheum. 2002;46:S415
ColussiGCatenaCBaroselliS. Omega-3 fatty acids: from biochemistry to their clinical use in the prevention of cardiovascular disease. Recent Patents Cardiovasc Drug Discov. 2007;2:13–21.
13.
ConnorWEConnerSL. Diet, atherosclerosis, and fish oil. Adv Intern Med. 1990;35:139–171.
14.
DurstineJLHaskellWL. Effects of exercise training on plasma lipids and lipoproteins. Exerc Sport Sci Rev. 1994;22:477–521.
15.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–2497.
16.
FletcherBBerraKAdesP. Managing abnormal blood lipids: a collaborative approach. Circulation. 2005;112:3184–3209.
17.
FrostRJAOttoCGeissHCSchwandtPParhoferKG. Effects of Atorvastatin versus Fenofibrate on lipoprotein profiles, low-density lipoprotein subfraction distribution, and hemorheologic parameters in type 2 diabetes mellitus with mixed hyperlipoproteinemia. Am J Cardiol. 2001;87:44–48.
18.
GriffinBAFreemanDJTaitGW. Role of plasma triglyceride in the regulation of plasma low-density lipoprotein (LDL) subfractions: relative contribution of small, dense LDL to coronary heart disease risk. Atherosclerosis. 1994;106:241–253.
19.
GrundySMPasternakRGreenlandPSmithSJrFusterV. Assessment of cardiovascular risk by use of multiple risk–factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation. 1999;100:1481–1492.
20.
GuskiewiczKMMarshallSWBailesJ. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007;396903–909.
21.
HamazakiKItomuraMHuanM. n-3 long-chain FA decrease serum levels of TG and remnant-like particle-cholesterol in humans. Lipids. 2003;384353–358.
22.
HarrisWSVon SchackyC. The omega-3 index: a new risk factor for death from coronary heart disease? Prev Med2004;39:212–220.
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomized, placebo-controlled trial. Lancet. 2002;360:7–22.
25.
HillAMBuckleyJDMurphyKJHowePR. Combining fish-oil supplements with regular aerobic exercise improves body composition and cardiovascular disease risk factors. Am J Clin Nutr. 2007;85:1267–1274.
26.
HokansonJEAustinMA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996;3:213–219.
27.
JeppesenJHeinHSuadicaniP. Triglyceride concentration and ischemic heart disease: an 8-year follow-up in the Copenhagen Male Study. Circulation. 1998;97:1029–1036.
28.
JialalIDevarajS. The role of oxidized low-density lipoprotein in atherogenesis. J Nutr. 1996;1264 Suppl1053S–1057S.
29.
JialalIDevarajS. Remnant lipoproteins: measurement and clinical significance. Clin Chem. 2002;48:217–219.
30.
KatanMBGrundySMJonesPLawMMiettinenTPaolettiRStresa Workshop Participants. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc. 2003;788965–978.
31.
KraussRM. Low-density lipoprotein subclasses and risk of coronary artery disease. Curr Opin Lipidol. 1991;2:248–252.
32.
Kris-EthertonPMHarrisWSAppelLJAmerican Heart Association Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106:2747–2757.
33.
KurikiKNagayaTTokudomeY. Plasma concentrations of (n-3) highly unsaturated fatty acids are good biomarkers of relative dietary fatty acid intakes: a cross-sectional study. J Nutr. 2003;133:3643–3650.
34.
LeafAWeberPC. Cardiovascular effects of n-3 fatty acids. N Engl J Med. 1988;318:549–557.
35.
LuoJRizkallaSWVidalH. Moderate intake of n-3 fatty acids for 2 months has no detrimental effect on glucose metabolism and could ameliorate the lipid profile in type 2 diabetic men. Results of a controlled study. Diabetes Care. 1998;21:717–724.
36.
MackWJKraussRMHodisHN. Lipoprotein subclasses in the Monitored Atherosclerosis Regression Study (MARS): treatment effects and relation to coronary angiographic progression. Arterioscler Thromb Vasc Biol. 1996;16:697–704.
37.
MarchioliR. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999;354:447–455.
38.
MaronBJChaitmanBEAckermanMJ. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular disease. Circulation. 2004;109:2807–2816.
39.
MaronBJ. Sudden death in young athletes. N Engl J Med. 2003;349:1064–1075.
40.
MaroonJCBostJ. Fish Oil: The Natural Anti-Inflammatory. Laguna, CA: Basic Health Books; 2006.
41.
MassaroMHabibALubranoL. The omega-3 fatty acid docosahexaenoate attenuates endothelial cyclooxygenase-2 induction through both NADP(H) oxidase and PKCeqinhibition. Proc Natl Acad Sci U S A. 2006;1034115184–15189.
42.
Mayo Clinic Press Release. Retired National Football League players at increased risk for heart problems. Medical News Today Web site. http://www.medicalnewstoday.com/articles/101971.php. Published March 29, 2008; accessed October 23, 2008.
MinihaneAMKhanSLeigh-FirbankEC. ApoE polymorphism and fish oil supplementation in subjects with an atherogenic lipoprotein phenotype. Arterioscler Thromb Vasc Biol. 2000;20:1990–1997.
45.
US Department of Health & Human Services. National Institute for Occupational Safety and Health (NIOSH) NFL Mortality Study. January 1994. http://www.cdc.gov/niosh/pdfs/nflfactsheet.pdf. Accessed October 23, 2008.
46.
PiolotABlacheDBouletL. Effect of fish oil on LDL oxidation and plasma homocysteine concentrations in health. J Lab Clin Med. 2003;141141–49.
47.
RajmanIKendallMJCrambR. Investigation of low-density lipoprotein subfractions as a coronary risk factor in normotriglyceridemic men. Atherosclerosis. 1996;125:231–242.
48.
ReiffelWSMcDonaldA. Antiarrhythmic effects of omega-3 fatty acids. Am J Cardiol. 2006;98suppl50i–60i.
49.
RivelleseAADe NataleCLilliS. Type of dietary fat and insulin resistance. Ann N Y Acad Sci. 2002;967:329–335.
50.
SacksFMAlaupovicPMoyeLA. VLDL, apolipoproteins B, CIII, and E, and risk of recurrent coronary events in the cholesterol and recurrent events (CARE) trial. Circulation. 2000;102:1886
51.
SatohNShimatsuAKotaniK. Purified eicosapentaenoic acid reduces small dense LDL, remnant lipoprotein particles, and C-Reactive protein in metabolic syndrome. Diabetes Care. 2007;30:144–146.
52.
SiscovickDSRaghunathanTEKingI. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA. 1995;274:1363–1367.
53.
SpagnoliLGBonannoESangiorgiGMaurielloA. Role of inflammation in atherosclerosis. J Nucl Med. 2007;48111800–1815.
54.
StampferMJKraussRMMaJ. A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. JAMA. 1996;276:882–888.
55.
StoneNJ. Fish consumption, fish oil, lipids, and coronary heart disease. Circulation. 1996;94:2337–2340.
56.
ThomasTRSmithBKDonahueOMAltenaTSJames-KrackeMSunGY. Effects of omega-3 fatty acid supplementation and exercise on low-density lipoprotein and high-density lipoprotein subfractions. Metabolism. 2004;536749–754.
57.
TornvallPBavenholmPLandouCde FaireUHamstenA. Relation of plasma levels and composition of apolipoprotein B-containing lipoproteins to angiographically defined coronary artery disease in young patients with myocardial infarction. Circulation. 1993;885 Pt 12180–2189.
58.
SutherlandWHRestieauxNJNyeER. IDL composition and angiographically determined progression of atherosclerotic lesions during Simvastatin therapy. Arterioscler Thromb Vasc Biol. 1998;18:577–583.
59.
YamashitaSSakaiNHiranoKIshigamiMMaruyamaTNakajimaNMatsuzawaY. Roles of plasma lipid transfer proteins in reverse cholesterol transport. Front Biosci. 2001;6:D366–D387.
