In vivo indexes of platelet and vascular function during fish-oil administration in patients with atherosclerosis

N Engl J Med. 1986 Apr 10;314(15):937-42. doi: 10.1056/NEJM198604103141501.


Populations that consume a diet rich in marine lipids may have a lower risk of atherosclerotic disease. Fish oil contains the N-3 polyunsaturated fatty acid eicosapentaenoate, and the biosynthesis of thromboxanes and prostacyclins from eicosapentaenoate (thromboxane A3 and prostaglandin I3), rather than from the usual precursor arachidonate (thromboxane A2 and prostaglandin I2), may help to reduce the risk. To examine this hypothesis, we studied the effect of eicosapentaenoate supplementation (10 g per day) for one month on the synthesis of thromboxanes and prostacyclins, as assessed by urinary metabolite excretion, in six patients with peripheral vascular disease and seven normal controls. Supplementation markedly increased the eicosapentaenoate content of phospholipids from red cells and platelets. Synthesis of the platelet agonist thromboxane A2, which was elevated in the patients at base line, declined by 58 percent during supplementation but did not reach normal values. The decline in thromboxane A2, which is synthesized from arachidonate, coincided with the formation of the inactive thromboxane A3, which is synthesized from eicosapentaenoate. A lower dose of eicosapentaenoate (1 g per day) was not sufficient to maintain the changes in thromboxane A2 synthesis. Platelet function was only moderately inhibited during eicosapentaenoate supplementation, consistent with incomplete suppression of thromboxane A2 synthesis. These studies show that a high dose of eicosapentaenoate alters the pattern of synthesis of thromboxanes and prostacyclins. However, effects comparable to those of aspirin require long-term administration in high doses. Whether other properties of fish oil might render it a more attractive antithrombotic therapy remains to be determined.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • 6-Ketoprostaglandin F1 alpha / analogs & derivatives
  • 6-Ketoprostaglandin F1 alpha / urine
  • Adult
  • Aged
  • Arteriosclerosis / blood*
  • Arteriosclerosis / urine
  • Bleeding Time
  • Blood Platelets / analysis
  • Blood Platelets / drug effects*
  • Dietary Fats / administration & dosage
  • Dietary Fats / pharmacology*
  • Eicosapentaenoic Acid / blood
  • Eicosapentaenoic Acid / metabolism
  • Eicosapentaenoic Acid / pharmacology
  • Epoprostenol / biosynthesis*
  • Erythrocytes / analysis
  • Fatty Acids / blood
  • Fish Oils / administration & dosage
  • Fish Oils / pharmacology*
  • Humans
  • Male
  • Middle Aged
  • Phospholipids / blood
  • Platelet Count
  • Platelet Factor 4 / analysis
  • Thromboxane A2 / biosynthesis
  • Thromboxane B2 / analogs & derivatives
  • Thromboxane B2 / urine
  • Thromboxanes / biosynthesis*
  • beta-Thromboglobulin / analysis


  • Dietary Fats
  • Fatty Acids
  • Fish Oils
  • Phospholipids
  • Thromboxanes
  • beta-Thromboglobulin
  • Platelet Factor 4
  • Thromboxane B2
  • Thromboxane A2
  • 6-Ketoprostaglandin F1 alpha
  • 2,3-dinor-thromboxane B2
  • 2,3-dinor-6-ketoprostaglandin F1alpha
  • Eicosapentaenoic Acid
  • Epoprostenol