The Use of ω-3 Poly-Unsaturated Fatty Acids in Heart Failure: A Preferential Role in Patients with Diabetes

To review the evidence for a beneficial effect of omega-3 PUFAs in heart failure (HF) and its co-morbidities, their possible preferential effect in diabetes and the potential mechanism for their benefit. We summarize the clinical studies which investigated the use of omega-3 PUFAs in patients with HF with an emphasis on diabetes. We briefly summarize the evidence for an effect of omega-3 PUFAs in patients with coronary artery disease (CAD), atrial fibrillation (AF) and ventricular arrhythmias. We also discuss the proposed mechanisms of omega-3 PUFA action in cardiovascular diseases. While there is emerging evidence for a beneficial effect of omega-3 PUFA supplementation in patients with HF, the evidence for other indications have been variable and conflicting. In HF patients with diabetes, omega-3 PUFAs may have a preferential therapeutic benefit. Randomized controlled trials did not show considerable beneficial effects of omega-3 PUFAs in other conditions such as CAD and AF. In a diabetic and insulin-resistant state, omega-3 PUFAs bind to the G-protein coupled receptor, GPR120, resulting in reduced cytokine production from inflammatory macrophages and improved signaling in adipocytes, leading to a reduction in insulin resistance. There is promising evidence showing that use of omega-3 PUFA supplementation improves clinical outcomes of HF patients with diabetes. Further clinical trials are needed in this regard.