Evolutionary aspects of diet, essential fatty acids and cardiovascular disease

Information from archaeological findings and studies from modern-day hunter-gatherers suggest that the Palaeolithic diet is the diet we evolved on and for which our genetic profile was programmed. During the Palaeolithic period the intake of omega-6 and omega-3 fatty acids was about equal. Epidemiological, experimental and clinical intervention studies have shown that omega-3 fatty acids affect the function of cells involved in atherothrombosis in numerous ways, including the modification of eicosanoid products in the cyclooxygenase and lipoxygenase pathways, the reduced synthesis of cytokines and platelet-derived growth factor by influencing gene expression and alterations in leukocyte and endothelial cell properties. In the secondary prevention of cardiovascular disease, omega-3 fatty acid supplementation leads to a decrease in cardiac deaths and total mortality. These effects are brought about without a decrease in plasma cholesterol levels, suggesting that the beneficial effects of omega-3 fatty acids in preventing sudden death are due to their antiarrhythmic properties. Because coronary heart disease is a multigenic and multifactorial disorder, it is essential that the patients are stratified by genetic susceptibility and disease entity, as well as sex, age and severity of disease. The composition of the diet must remain constant throughout the intervention period and also the ratios of saturated fat to unsaturated fat and the ratio of omega6:omega-3 taken into consideration. Trans fatty acids should not comprise more than 2% of energy. The dose, duration and mechanisms involved in the prevention and management of cardiovascular disease following omega-3 fatty acid ingestion or supplementation need to be further investigated by double-blind controlled clinical trials. (Eur Heart J Supplements 2001; 3 (Suppl D): D8–D21) ? 2001 The European Society of Cardiology