n-3 PUFA and Endothelial Dysfunction: Exploring the Link between Cardiovascular Disease and Risk Reduction


Wachira Jirarattanarangsri


     The loss of normal vascular function has an etiologic role in hypertension, atherogenesis, and vascular reactivity which lead to cardiovascular disease (CVD). Several societies across the world have established dietary recommendations for eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), either from the intake of oily fish or EPA- and DHA-containing supplements that are principally for CVD risk reduction. There is growing evidence that dietary n-3 PUFA may reduce the development of CVD. Because of this, animal and human trials have been investigated for biochemical and metabolic parameters. This article provides information on the benefits of n-3 PUFA by showing the evidence from animal and clinical human studies which suggest that increasing intakes n-3 PUFA may reduce the risk of CVD by improving biomarkers, endothelial function and vascular reactivity.


Armah, C. K., Jackson, K. G., Doman, I., James, L., Cheghani, F., & Minihane, A. M. (2008). Fish oil fatty acids improve postprandial vascular reactivity in healthy men. Clinical Science, 114(11), 679-686.

Assman, G., Cullen, P., Jossa, F., Barry, L., & Mancini, M. (1999). Coronary heart disease: reducing the risk: the scientific background to primary and secondary prevention of coronary heart disease a worldwide view. Arteriosclerosis, Thrombosis, and Vascular Biology, 19, 1819-1824.

Blankenberg, S., Barbaux, S., & Tiret, L. (2003). Adhesion molecules and atherosclerosis. Atherosclerosis, 170(2), 191-203.

Brown, A. A., & Hu, F. B. (2001). Dietary modulation of endothelial function: implications for cardiovascular disease. The American Journal of Clinical Nutrition, 73(4), 673-686.

Cappuccio, F. P., Cook, D. G., Atkinson, R. W., & Strazzullo, P. (1997). Prevalence, detection, and management of cardiovascular risk factors in different ethnic groups in south London. Heart, 78(6), 555-563.

Christon, R. A. (2003). Mechanisms of action of dietary fatty acids in regulating the activation of vascular endothelial cells during atherogenesis. Nutrition Reviews, 61(8), 272-279.

Davignon, J., & Ganz, P. (2004). Role of endothelial dysfunction in atherosclerosis. Circulation, 109(23 suppl 1), III-27-III-32.

Davis, H. R., Bridenstine, R. T., Vesselinovitch, D., & Wissler, R. W. (1987). Fish oil inhibits development of atherosclerosis in rhesus monkeys. Arteriosclerosis, Thrombosis, and Vascular Biology, 7(5), 441-449.

Engler, M. M., Engler, M. B., Pierson, D. M., Molteni, L. B., & Molteni, A. (2003). Effects of docosahexaenoic acid on vascular pathology and reactivity in hypertension. Experimental Biology and Medicine, 228(3), 299-307.

Fahs, C. A., Yan, H., Ranadive, S., Rossow, L. M., Agiovlasitis, S., Wilund, K. R., & Fernhall, B. (2010). The effect of acute fish-oil supplementation on endothelial function and arterial stiffness following a high-fat meal. Applied Physiology, Nutrition, and Metabolism, 35(3), 294-302.

Félétou, M., & Vanhoutte, P. M. (2006). Endothelial dysfunction: a multifaceted disorder (the Wiggers Award Lecture). American Journal of Physiology-Heart and Circulatory Physiology, 291(3), H985-H1002.

Gogus, U., & Smith, C. (2010). N-3 Omega fatty acids: a review of current knowledge. International Journal of Food Science & Technology, 45(3), 417-436.

Gleissner, C. A., Leitinger, N., & Ley, K. (2007). Effects of native and modified low-density lipoproteins on monocyte recruitment in atherosclerosis. Hypertension, 50(2), 276-283.

Harris, W. S. (2004). Fish oil supplementation: evidence for health benefits. Cleveland Clinic Journal of Medicine, 71(3), 208-221.

Hu, F. B., Bronner, L., Willett, W. C., Stampfer, M. J., Rexrode, K. M., Albert, C. M., ... & Manson, J. E. (2002). Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA, 287(14), 1815-1821.

Johansen, O., Seljeflot, I., Høstmark, A. T., & Arnesen, H. (1999). The effect of supplementation with omega-3 fatty acids on soluble markers of endothelial function in patients with coronary heart disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 19(7), 1681-1686.

Jung, U. J., Torrejon, C., Tighe, A. P., & Deckelbaum, R. J. (2008). n-3 Fatty acids and cardiovascular disease: mechanisms underlying beneficial effects. The American Journal of Clinical Nutrition, 87(6), 2003S-2009S.

Klabunde, R. (2011). Cardiovascular physiology concepts. Baltimore, USA: Lippincott Williams & Wilkins.

Kris-Etherton, P. M., Harris, W. S., Appel, L. J., & Nutrition Committee. (2002). Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation, 106(210), 2747-2757.

Lee, K. W., & Lip, G. Y. H. (2003). The role of omega-3 fatty acids in the secondary prevention of cardiovascular disease. QJM, 96(7), 465-480.

Libby, P. (2012). Inflammation in atherosclerosis. Arteriosclerosis, Thrombosis, and Vascular Biology, 32(9), 2045-2051.

Lopez-Garcia, E., Schulze, M. B., Manson, J. E., Meigs, J. B., Albert, C. M., Rifai, N., ... Hu, F. B. (2004). Consumption of (n-3) fatty acids is related to plasma biomarkers of inflammation and endothelial activation in women. The Journal of Nutrition, 134(7), 1806-1811.

Massaro, M., Scoditti, E., Carluccio, M. A., & De Caterina, R. (2008). Basic mechanisms behind the effects of n-3 fatty acids on cardiovascular disease. Prostaglandins, Leukotrienes and Essential Fatty Acids, 79(3), 109-115.

Matsumoto, T., Nakayama, N., Ishida, K., Kobayashi, T., & Kamata, K. (2009). Eicosapentaenoic acid improves imbalance between vasodilator and vasoconstrictor actions of endothelium-derived factors in mesenteric arteries from rats at chronic stage of type 2 diabetes. Journal of Pharmacology and Experimental Therapeutic, 329(1), 324-334.

Mendis, S., Puska, P., & Norrving, B. (2011). Global atlas on cardiovascular disease prevention and control 2011. France: World Health Organization.

Mori, T. A., Watts, G. F., Burke, V., Hilme, E., Puddey, I. B., & Beilin, L. J. (2000). Differential effects of eicosapentaenoic acid and docosahexaenoic acid on vascular reactivity of the forearm microcirculation in hyperlipidemic, overweight men. Circulation, 102(11), 1264-1269.

Patey, N., Vazeux, R., Canioni, D., Potter, T., Gallatin, W. M., & Brousse, N. (1996). Intercellular adhesion molecule-3 on endothelial cells. Expression in tumors but not in inflammatory responses. The American Journal of Pathology, 148(2), 465-472.

Schmitt, C. A., & Dirsch, V. M. (2009). Modulation of endothelial nitric oxide by plant-derived products. Nitric Oxide, 21(2), 77-91.

Shaw, D. I., Hall, W. L., Jeffs, N. R., & Williams, C. M. (2007). Comparative effects of fatty acids on endothelial inflammatory gene expression. European Journal of Nutrition, 46(6), 321-328.

Simopoulos, A. P. (2008). The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Experimental Biology and Medicine, 233(6), 674-688.

Stanner, S. (Ed.). (2008). Cardiovascular Disease: Diet, Nutrition and Emerging Risk Factors (The Report of the British Nutrition Foundation Task Force). Bath, UK: John Wiley & Sons.

Stocker, R., & Keaney, J. F. (2004). Role of oxidative modifications in atherosclerosis. Physiological Reviews, 84(4), 1381-1478.

Sumpio, B. E., Riley, J. T., & Dardik, A. (2002). Cells in focus: endothelial cell. The International Journal of Biochemistry & Cell Biology, 34(12), 1508-1512.

van den Elsen, L. W., Spijkers, L. J., van den Akker, R. F., van Winssen, A. M., Balvers, M., Wijesinghe, D. S., ... Peters, S. L. (2014). Dietary fish oil improves endothelial function and lowers blood pressure via suppression of sphingolipid-mediated contractions in spontaneously hypertensive rats. Journal of Hypertension, 32(5), 1050-1058.

Wang, C., Harris, W. S., Chung, M., Lichtenstein, A. H., Balk, E. M., Kupelnick, B., ... & Lau, J. (2006). n-3 Fatty acids from fish or fish-oil supplements, but not α-linolenic acid, benefit cardiovascular disease outcomes in primary-and secondary-prevention studies: a systematic review. The American Journal of Clinical Nutrition, 84(1), 5-17.

West, S. G., Hecker, K. D., Mustad, V. A., Nicholson, S., Schoemer, S. L., Wagner, P., ... Kris-Etherton, P. M. (2005). Acute effects of monounsaturated fatty acids with and without omega-3 fatty acids on vascular reactivity in individuals with type 2 diabetes. Diabetologia, 48(1), 113-122.

Zhu, B. Q., Smith, D. L., Sievers, R. E., Isenberg, W. M., & Parmley, W. W. (1988). Inhibition of atherosclerosis by fish oil in cholesterol-fed rabbits. Journal of the American College of Cardiology, 12(4), 1073-1078.

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How to Cite
JIRARATTANARANGSRI, Wachira. n-3 PUFA and Endothelial Dysfunction: Exploring the Link between Cardiovascular Disease and Risk Reduction. Naresuan University Journal: Science and Technology (NUJST), [S.l.], v. 25, n. 1, p. 1-11, feb. 2017. ISSN 2539-553X. Available at: <http://www.journal.nu.ac.th/NUJST/article/view/1670>. Date accessed: 03 july 2020.