In the prevention and treatment of cardiovascular disease, in addition to the already proven effective treatment of dyslipidemia, hypertension and diabetes mellitus, omega-3 polyunsaturated fatty acids (n-3 PUFAs) are considered as substances with additive effects on cardiovascular health. N-3 PUFAs combine their indirect effects on metabolic, inflammatory and thrombogenic parameters with direct effects on the cellular level. Eicosapentaenoic acid (EPA) seems to be more efficient than docosahexaenoic acid (DHA) in the favorable mitigation of atherothrombosis due to its specific molecular properties. The inferred mechanism is a more favorable effect on the cell membrane. In addition, the anti-fibrotic effects of n-3 PUFA were described, with potential impacts on heart failure with a preserved ejection fraction. Furthermore, n-3 PUFA can modify ion channels, with a favorable impact on arrhythmias. However, despite recent evidence in the prevention of cardiovascular disease by a relatively high dose of icosapent ethyl (EPA derivative), there is still a paucity of data describing the exact mechanisms of n-3 PUFAs, including the role of their particular metabolites. The purpose of this review is to discuss the effects of n-3 PUFAs at several levels of the cardiovascular system, including controversies.

Institute and Department of Physiology and Immunology Faculty of Medicine Osijek University Josip Juraj Strossmayer Osijek J Huttlera 4 HR 31000 Osijek Croatia

Laboratory for Atherosclerosis Research Center for Experimental Research Department of Cardiology Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Scientific Centre of Excellence for Personalized Health Care University Josip Juraj Strossmayer Osijek Trg Sv Trojstva 3 HR 31000 Osijek Croatia

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Ginger Extract and Omega-3 Fatty Acids Supplementation: A Promising Strategy to Improve Diabetic Cardiomyopathy