European Heart Journal Supplements (2001) 3 (Supplement D), D8–D21
Evolutionary aspects of diet, essential fatty acids and
cardiovascular disease
A. P. Simopoulos
The Center for Genetics, Nutrition and Health, Washington DC, U.S.A.
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 interven-
tion 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 ef-
fects 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 suscepti-
bility 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 omega-
6: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