TY - JOUR T1 - Importance of maintaining a low omega-6/omega-3 ratio for reducing platelet aggregation, coagulation and thrombosis JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2019-001011 VL - 6 IS - 1 SP - e001011 AU - James J DiNicolantonio AU - James OKeefe Y1 - 2019/05/01 UR - http://openheart.bmj.com/content/6/1/e001011.abstract N2 - The idea that long-chain marine omega-3s can prevent cardiovascular disease is decades old. This idea began with the Greenland Inuit who were noted to have a lower risk of cardiovascular disease.1 Indeed, the Inuit, with their high intake of long-chain omega-3s, have been noted to have a lower platelet count, reduced platelet reactivity, prolonged bleeding times and a lower ratio of proaggregatory thromboxanes versus antiaggregatory prostacyclins.2 And it has been known for a long time that marine omega-3s (from salmon, mackerel, fish oil or cod liver oil) inhibit platelet aggregation.Clinical studies in humans clearly show that marine omega-3s provide antiplatelet effects. Indeed, a meta-analysis of 15 randomised controlled trials (RCT) in humans has confirmed that omega-3 polyunsaturated fatty acids (PUFA) inhibit platelet aggregation.3 Marine omega-3 PUFAs also may help overcome aspirin resistance.4 In healthy borderline overweight men, 3 g of omega-3 PUFAs for 4 weeks lowered fibrinogen, thrombin and factor V levels; these benefits occurred mainly in those with high fibrinogen carrying alpha-chain fibrinogen polymorphism.5 Marine omega-3s also have the ability to reduce von Willebrand factor (vWF; a platelet activator factor), whole blood viscosity, and can improve red blood cell flexibility (deformability).6 7 In a 5-week double-blind placebo-controlled study in 30 healthy subjects, 2.52 g/day of omega-3 PUFAs as compared with 1.26 g/day, significantly decreased plasma viscosity, red blood cell rigidity and systolic blood pressure.8 Thus, higher doses of marine omega-3 seem to be more effective antithrombotic benefits.One study in healthy adults found that fish oil (providing 6 g of eicosapentaenoic acid (EPA)/day), but not vegetable oil, reduced platelet adhesiveness.9 In another study, supplementation with 3.6 g of omega-3 PUFA from fish oil reduced platelet aggregation, whereas 25 g of soy lecithin (providing 1.5 g omega-6, 0.5 g omega-3) increased … ER -