Omega-3 Supplements May Protect Children With High Cholesterol From Developing Heart Disease

A graphic of two kids running with a heart and a cloud in the background.

By Vivian Mason

Can a daily regimen of omega-3 supplements help children with high cholesterol avoid heart disease later in life?

A study funded by the National Institutes of Health and headed by Marguerite M. Engler, PhD, RN, MS, FAHA, professor at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University (USU), showed that the omega-3 fatty acid supplement eicosapentaenoic acid, or EPA, may help prevent children with high cholesterol from developing heart disease. 

Dr. Marguerite Engler (Photo credit: Tom Balfour, USU)
Dr. Marguerite Engler (Photo credit: Tom Balfour, USU)
The human body also produces EPA and another omega-3 fatty acid, docosahexaenoic acid, or DHA, in small amounts from alpha-linolenic acid, which is derived from plant oils like flaxseed or canola, but the only practical way to increase the amounts of these fatty acids is to obtain them directly in the diet from fish, other seafood, or fish oil supplements. 

“Our mission was always to find a type of nutritional intervention, ideal supplement, or some type of natural product that patients could take to improve their heart health without side effects,” says Engler. “Our research goal was to prevent future heart disease or at least help reduce current symptoms in those with more advanced heart disease.”

As part of a five-year study that looked at ways to treat high cholesterol in children through nutrition, Engler’s early research investigated DHA supplements administered daily for six weeks to 20 children (ages 9 through 19) with hereditary high cholesterol. This hereditary condition is called heterozygous familial hypercholesterolemia, which occurs when one of the parents carries the gene that predisposes the child to have high cholesterol. She found that they already had evidence of poor blood vessel function. However, after being given the DHA supplements, their function returned to what is normally found in healthy children.  

For six weeks, the DHA supplements reversed blood vessel function that can lead to early heart disease in these children. DHA had another unexpected result. When children were given DHA, the blood low-density lipoproteins (LDLs)―which contain smaller subparticles (such as LDL-1, LDL-2, etc.)―were made bigger, fluffier, and more buoyant by DHA. Thus, these particles became less likely to be taken up into the arteries to develop into atherosclerotic plaque, and they actually improved cholesterol quality and reduced the risk of developing heart disease in these children. 

In her current study, Engler and her team focused on the effects of EPA and the Mediterranean diet on hypercholesterolemic children predisposed to heart disease. 

“It’s an adventure in so many ways to discover the effects of these supplements and nutrients as we explore the physiology in the vasculature,” Engler remarks. 

Basically, children were counseled and started on a Mediterranean diet that was rich in “healthy” fats from oils and nuts, as well as daily fruits, vegetables, and whole grains. They were also given EPA supplements for 6 weeks. Researchers measured fatty acid levels in children at the beginning of the study, after the Mediterranean diet for six weeks, and again after the diet plus EPA supplements for six weeks. Taking EPA supplements for six weeks increased the blood levels of both EPA and DPA. 

DPA has anti-inflammatory properties. It prevents platelets from sticking together and also provides cardioprotective benefits. Dr. Engler points out that her team’s findings show the potential for omega-3 fatty acid supplements to be used to transform the blood lipid profile of children at high risk of heart disease into a more preferred anti-inflammatory state associated with a decreased risk of heart disease and healthy aging.

High cholesterol circulates over time, exposing and accumulating in the arteries. This can lead to early heart disease. One of the parents of the children being studied had heart disease that required an emergency interventional procedure to open up his coronary arteries while he was in his 40s. Unfortunately, like the parent, the child would likely experience heart disease early in adulthood if their condition is left untreated.

Adds Engler, “It’s a real issue because so many children may have high cholesterol and don’t know it. They’re normal weight children, and there’s nothing to indicate that they have the condition. It’s only identified through a blood test or family history, and the experts recommend universal lipid screening for familial hypercholesterolemia in all children between the ages of nine to 11 so they can be identified and treated early. It should also be checked at two years of age if there is a strong family history of heart disease.” Otherwise, it could develop into early coronary artery disease and lead to a heart attack or stroke. 

Two kids make salads
Dr. Engler and her research team studied the effects of omega-3 supplements on children with high cholesterol. (Photo courtesy of Dr. Marguerite Engler)

As the global obesity rate in adolescents is rising, increasing the risk of heart disease when added to hypercholesterolemia, the importance of Engler’s research cannot be overstated. The typical treatment for hypercholesterolemia is cholesterol-lowering statin drugs, but these omega-3 fatty acid supplements may provide an alternative, safe, and natural option for therapy.

Engler became interested in this research years ago because the only treatment recommendation at the time for children with hypercholesterolemia was to start them on a low-fat diet and statin drugs. 

“We were just concerned that all of the long-term effects of these drugs weren’t known,” Engler observes. “Certainly, we knew cholesterol levels had to be lowered to prevent heart disease, but we thought there might be a better way to do it. So, our early studies suggested that using one of the omega-3 fatty acids (DHA) found in fish oil offered some cardioprotection. Now, we are also seeing a benefit with EPA supplements by altering the lipid profile in hypercholesterolemia.”

Engler’s study has been cited by consensus panels and pediatricians. The American Heart Association also released a Scientific Statement on the treatment of lipid disorders in children and adolescents that included some of her research. In addition, Engler’s work was presented recently at the American Physiological Society's annual meeting at Experimental Biology 2021. 

Currently, Engler is planning a new study to look at military service members, retirees, and their beneficiaries at Walter Reed National Military Medical Center who have mild heart disease. She wants to provide various nutrients with cardioprotective potential [e.g., black currant or green-lipped mussel supplements with omega-3 fatty acids (even more powerful than those found in fish oil)] to see how patients will respond to them. In addition, she’s also interested in investigating how flavonoids found in berries can affect the heart. 

“That’s another exciting area of study―to see if specific flavonoids have any effect on cardiovascular health and, if so, through what mechanisms.” 

Engler’s research and the research of her sister, Dr. Mary Engler, also showed that dark chocolate, high in flavonoids and given 1.6 oz daily for two weeks, improves vascular health in adults. 

Engler acknowledges that what she has found most rewarding about her work so far is “making a difference and helping patients have better heart health, especially children. To see them improve so well and see their smiling faces is the most satisfying feeling in the world.”