American Journal of Nursing Research
ISSN (Print): 2378-5594 ISSN (Online): 2378-5586 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Nursing Research. 2018, 6(1), 30-38
DOI: 10.12691/ajnr-6-1-5
Open AccessArticle

Dietary Intervention Rich in Omega-3 Fatty Acid to Reduce Risk Factors of Cardiovascular Diseases at High Risk Patients

Naglaa El Mokadem1, and Shimaa EL-Sayed Ibraheem1

1Medical Surgical Nursing Department, Faculty of Nursing - Menoufia University

Pub. Date: February 28, 2018

Cite this paper:
Naglaa El Mokadem and Shimaa EL-Sayed Ibraheem. Dietary Intervention Rich in Omega-3 Fatty Acid to Reduce Risk Factors of Cardiovascular Diseases at High Risk Patients. American Journal of Nursing Research. 2018; 6(1):30-38. doi: 10.12691/ajnr-6-1-5


Background: Cardiovascular Disease (CVD) is the number one killer in developed countries. In Egypt, CVD deaths account for 21.7% of total deaths. Patients at high risk have higher CVD mortality and morbidity following a cardiac event. Hypertension, Diabetes Mellitus (DM), Dyslipdemia and lack of physical activity have been identified as CAD risk factors. Also, inflammatory response and diet have been identified as additional factors that may influence the development of CAD. The relationship between inflammatory reaction and risk of CVD events is consistent and independent of other risk factors. There is evidence about the benefits of omega-3 fatty acids on CVD. Omega-3 fatty acids improve heart health by reducing triglyceride levels, decreasing the growth of atherosclerotic plaques, improving arterial endothelial function, lowering blood pressure, and reducing the risk of thrombosis. Further research is needed to confirm the cardio protective benefits of omega-3 fatty acids. Thus, the purpose of the current study was to examine the effect of dietary intervention rich in omega-3 fatty acids on reducing CAD risk factors for high risk patients. Methods: A quasi experimental (Pre- post test) design was used. Sample: A convenience sample of 100 patients with one or more risk factors of CAD. Setting: the study was conducted in the out-patient clinics at Menoufia University Hospital at Shebein El- Kom City. Tools: a) Interviewing Questionnaire; b) Cardiovascular Risk Assessment Scale (CVRAS); c) Obligatory Exercise Questionnaire; d) Serological level of Interleukin-2 (IL-2), C-reactive proteins, lipid profile and blood glucose level. Results: There was a statistically significant reduction in CAD risk score post intervention (13.50 ± 2.95) compared to pre intervention (22.94 ± 3.13). There was a statistically significant reduction in the inflammatory response, IL-2 (23.55 ± 4.44); C-reactive proteins (2.71 ± 1.39) post intervention compared to pre intervention (31.90 ± 4.80); (4.10 ± 1.38) respectively and physical activity (Paired t- test 10.71, P= 0.05). Conclusion: Omega-3 fatty acids can favorably decrease cardiovascular risk-factor, for primary and secondary prevention of CVD. Recommendation: A diet rich in Omega-3 fatty acids should be included when designing a dietary intervention targeting individuals at high risk for CVD.

omega-3 fatty acid cardiovascular risk dietary intervention inflammatory response physical activity BMI blood glucose blood pressure

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Mendis S., Puska P., Norrving B. (2014). Using omega 3 fatty acid for cardiovascular disease prevention and control. The World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization. Critical care Nursing. 6; (12): 143-55.
[2]  World Health Organization, (2014). The Atlas of Heart Disease and Stroke. Available at:
[3]  National Center for Health Statistics (2014). Health data interactive: final mortality data. Available at: http//
[4]  David, Jenkins, Cyril, Kendall, Marchie, and Dorothea, (2013). Effect of nutrition rich with omega 3 fatty acid on cardiovascular disease risk factors. Journal of Clinical Nutrition. 290, 4, 200-224.
[5]  American Heart Association (2014). Risk Factors and Coronary Heart Disease: AHA Scientific Position. Available at
[6]  Appel L.J., Brands M.W., Daniels S.R., Karanja N., Elmer P.J., Sacks F.M. (2015). Dietary approaches rich with omega 3 fatty acid to lower and treat hypertension a scientific statement from the American Heart Association. Hypertension; 47 (2): 296-308.
[7]  Raskin P. (2011). Omega 3 fatty acid for reducing hypertension in adults with diabetes. Clinical Diabetes; 21 (3): 120-1.
[8]  Kochanek K.D., Xu J., Murphy S.L. (2011). Dietary supplementation of omega 3 fatty acid on hypertensive patient with diabetes type 2. Critical Care Nursing; 10, 22, 256-76.
[9]  Centers for Disease Control and Prevention CDC, (2013). Diabetes mellitus. National Center for Health Statistics National Vital Statistics System, Available at Mellitus/data/.html.
[10]  Ridker PM. (2003). Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation; 107: 363-369.
[11]  Pradhan AD, Manson JE, Rifai N, et al. C-reactive protein, interleukin 6, and the risk of developing type 2 diabetes mellitus. JAMA. 2001; 286: 327-334.
[12]  Freeman DJ, Norrie J, Caslake MJ, et al. C-reactive protein is an independent predictor of risk for the development of diabetes in the West of Scotland Coronary Prevention Study. Diabetes. 2002; 51: 1596-1600.
[13]  Joshi, Islam, Pais, Reddy, Doraira, Pandey, and Kazmi (2012). Effect of omega 3 fatty acid on risk factors for prevention of early myocardial infarction in South Asians Compared with individuals in other countries. Journal of American Medical Association. 297: 286-94.
[14]  National Center for Chronic Disease Prevention and Health Promotion (2011). Improving health and quality of life for all people at high risk for cardiovascular diseases - halting the epidemic by making health easier.
[15]  Critchley and Capewell (2013). Associations of omega-3 fatty acid with risk factors for coronary heart disease. European Journal of Clinical Nutrition; 54: 865-71.
[16]  Kris-Etherton, Harris and Appel. (2014). Omega-3 fatty acid protects against coronary artery diseases and hypercholesterolemic and physical inactivity. Journal of Nutrition.134:3250-6.
[17]  Sanders, Oakley and Mille (2012). Effect of a small quantity of omega-3 Fatty Acid on physical activity and cardiovascular risk factors in NIDDM. Diabetes Care. 17 (1), 37-44.
[18]  American Heart Association, (2007). AHA/ACC Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2006 Update.
[19]  Mosca, L. (2002). C-reactive protein: To screen or not to screen? New England Journal of Medicine, 347 (20), 1615-1617.
[20]  Entman M.L., Smith C.W. (2007). Post reperfusion inflammation: a model for reaction to injury in cardiovascular disease. Cardiovasc Res; 9: 1301-1311.
[21]  Ridker, P. M., Rifai, N., Rose, L., Burning, J. E.and Cook, N. R. (2002).Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. New The New England Journal of Medicine Volume 347 Number 20: November 14, 2002, pgs. 1557-1565.
[22]  Levy, Atkinson, Bell, and Hadden, (2011). Effect of omega 3 fatty acid on e progression of secondary dietary failure in type 2 diabetes milletus:the 10 years follow- up. Diabetic Medicine. 15, 4, 290-296.
[23]  Bakris WE, Hill CX, Mancia CV, Steyn FL, Black GD, Pickering TE, (2011). Blood levels of long-chain n-3 fatty acids and the risk of Heart disease sudden death. New England Journal of Medicine; 346: 1113-8.
[24]  Girard and Mauduit, (2010). The lipid trial or how to reduce residual cardiovascular risk? Ann Endocrinol (Paris). Mar; 71 (2): 89-94.
[25]  Watts, GF., Sullivan DR., Poplawski N., Van Bockxmeer F., et al., (2011). Familial hypercholesterolaemia: A model of care for Australasia. Atherosclerosis Supplements; 12 (2) 221-263.
[26]  Reinberg (2012). Measurements of body mass index. Systemic data.Available at
[27]  Centers for Disease Control and Prevention CDC, (2010) .Over weight and obesity. Data and statistic. Map. Available at Accessed June 2011.
[28]  Kannel, McGee, and Gordon, (2010). The Framingham Heart Study and the Epidemiology of Cardiovascular Disease: A Historical Perspective. Circulation; 59: 8-13.
[29]  Fuster, V. and Kelly, B. (2010) Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Washington (DC): National Academies Press (US). The National Academies Collection: Reports funded by National Institutes of Health.
[30]  Thompson & Pasman (1988). Physical Activity measurement using the Obligatory Exercise questionnaire. Available at: http//www.
[31]  Joann (2010). Reliability for the Obligatory Exercise questionnaire of obese women: A meta-analysis of randomized controlled trials. American Journal of Medicine. 112: 298-304.
[32]  Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Despr├ęs JP, Fullerton HJ, Howard VJ, et al.. (2015). Heart disease and stroke statistics--2015 update: a report from the American Heart Association Circulation Jan 27; 131(4): e29-322.
[33]  Chowdhury R, Stevens S, Gorman D, Pan A, Warnakula S, Chowdhury S, Ward H, Johnson L, Crowe F, Hu FB, Franco OH. (2012).Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and meta-analysis. BMJ; 345: e6698.
[34]  Singh R.B., Niaz M.A., Sharma J.P., Kumar R., Rastogi V., Moshiri M. (2013). Randomized, double-blind, placebo-controlled trial of omega-3 fatty acid on lowering blood glucose level and blood pressure in patients with suspected coronary artery disease the Indian experiment of infarct survival. Cardiovascular Drugs Therapy, 11: 485-91.
[35]  Appel L.J., Miller E.R., Seidler A.J. & Whelton P.K. (2013). Does supplementation of diet with omega 3 fatty acid reduce blood pressure? A meta-analysis of controlled clinical trials. Archive of Internal Medicine. 153, 1429-1438.
[36]  Lai Y.H., Petrone A.B., Pankow and West S.G. (2013). Acute effects of omega fatty acids on glucose level in individuals with type 2 diabetes. Clinical Nutrition. 32: 966-969.
[37]  Nettleton J.A. and Katz R. (2012). Omega 3 polyunsaturated fatty acids for reduction of glucose level in type 2 diabetes: a Review. Journal of the American Dietetic Association, 105(3):428-40.
[38]  Leena, Ahmad, Jill and Crandall (2010). Omega-3 polyunsaturated fatty acids: Their potential role in blood glucose level and management. American Journal of Clinical Nutrition. 2000; 71: 179S-88S.
[39]  Engler, Newby, and Alicja (2014). Omega-3 fatty acids: Role in lowering blood pressure and cardiovascular health and disease. Journal of Cardiovascular Nursing. 21: 17-24.
[40]  Grobbee D.E., Donders W.S., Appel L.J. (2013). Consumption of omega-3 fatty acids and reduction of blood pressure and cardiovascular disease. The Nutrition Committee: AHA scientific statement. Critical Care Nursing; 106: 2747-57.
[41]  Harper C.R., Edwards M.C., Jacobson T.A. (2013). Omega-3 fatty acid supplementation does not affect plasma lipoprotein concentration or particle size in human subjects. Journal of Nutrition. 136: 2844-8.
[42]  Pazoki (2007). Effectiveness of omega 3 fatty acid on reducing blood pressure for 8-week and Cardiovascular risk factors. Cardiovascular Journal. 17(11): 145-9.
[43]  Barbara, Howard, Horn, Judith, Manson, and JoAnn (2006). The effect of 1g of omega 3 fatty acid on reducing blood pressure. Hypertension. 6(22): 2344.
[44]  Faezeh P, Hassan M, Javad Z, and Ali D.(2013).Effects of Omega-3 Supplementation on Blood Pressure in Patients with Type 2 Diabetes: A Double-Blind, Placebo-Controlled Clinical Trial. iranian journal of diabetes and obesity, volume 5, 54-59.
[45]  Liu J.C, Conklin S.M, Manuck S.B, Yao J.K, Muldoon M.F. (2011).Long-chain omega-3 fatty acids and blood pressure. American journal of hypertension; 24(10): 1121-6.
[46]  Adams J, Sibbritt D, Lui CW, Broom A, Wardle J. (.2013). Omega-3 fatty acid supplement use in the 45 and Up Study Cohort. BMJ Open; 3:pii: e002292.
[47]  Lewis, Kuller, Laura, Kinzel, Kelley, Pettee (2013). Role of omega-3 fatty acids in physical inactivity, metabolic syndrome, and cardiovascular diseases: a review of the evidence. Journal of Physiology and Biochemical 69: 633-651, 2013.
[48]  Leeder, Greenburg, Liu, Esson (2010). A role of omega 3 fatty acid on cardiovascular disease risk factors in developing economies. New York: Columbiardiol. 14, 5: 188-199. Available at
[49]  Polit, D. F. & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.