Fish oil supplementation (FOS) is known to have cardiovascular benefits. However, the effects of FOS on
thrombosis are incompletely understood. We sought to determine if the use of FOS is associated with lower indices of atherothrombotic risk in patients with suspected
coronary artery disease (sCAD). This is a subgroup analysis of consecutive patients with sCAD (n=600) enrolled in the Multi-Analyte, Thrombogenic, and
Genetic Markers of
Atherosclerosis study. Patients on FOS were compared with patients not on FOS.
Lipid profile was determined by vertical density gradient ultracentrifugation (n=520), eicosapentaenoic acid+docosahexaenoic
acid was measured by gas chromatography (n=437), and AtherOx testing was performed by immunoassay (n=343). Thromboelastography (n=419),
ADP- and
collagen-induced platelet aggregation (n=137), and urinary
11-dehydrothromboxane B2 levels (n=259) were performed immediately before elective coronary angiography. In the total population, FOS was associated with higher eicosapentaenoic acid+docosahexaenoic
acid content (p<0.001), lower
triglycerides (p=0.04), total
very low-density lipoprotein cholesterol (p=0.002),
intermediate-density lipoprotein cholesterol (p=0.02), and AtherOx levels (p=0.02) but not in patients on
lipid-lowering
therapy. Patients not on
lipid-lowering
therapy taking FOS had lower
very low-density lipoprotein cholesterol,
intermediate-density lipoprotein cholesterol, remnant
lipoproteins,
triglycerides,
low-density lipoprotein cholesterol, AtherOx levels,
collagen-induced platelet aggregation,
thrombin-induced platelet-
fibrin clot strength, and shear elasticity (p<0.03 for all). In
clopidogrel-treated patients, there was no difference in
ADP-induced aggregation between FOS groups. Patients on FOS had lower urinary
11-dehydrothromboxane B2 levels regardless of
lipid-lowering
therapy (p<0.04). In conclusion, the findings of this study support the potential benefit of FOS for atherothrombotic risk reduction in sCAD with the greatest benefit in patients not receiving
lipid-lowering
therapy. Future prospective studies to compare FOS with
lipid-lowering
therapy and to assess the independent effects of FOS on thrombogenicity are needed.