Laboratory Section - Measurement of Long-Chain Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor

IMPORTANT REMINDER

This Medical Policy has been developed through consideration of medical necessity, generally accepted standards of medical practice, and review of medical literature and government approval status.

Benefit determinations should be based in all cases on the applicable contract language. To the extent there are any conflicts between these guidelines and the contract language, the contract language will control.

The purpose of medical policy is to provide a guide to coverage. Medical Policy is not intended to dictate to providers how to practice medicine. Providers are expected to exercise their medical judgment in providing the most appropriate care.

DESCRIPTION

Epidemiologic studies have reported that subjects who eat a diet high in fish have a reduced risk of sudden cardiac death. Fish are rich in long-chain omega-3 fatty acids, and it has been hypothesized that these fatty acids may be responsible for the beneficial effect. Long-chain omega-3 fatty acids may be detected in the red cell membrane using gas chromatography. It has been suggested this measurement may be clinically useful as a cardiac risk factor for sudden cardiac death.

POLICY/CRITERIA

Measurement of long-chain omega-3 fatty acids in red blood cell membranes, including but not limited to its use as a cardiac risk factor, is considered investigational.

SCIENTIFIC BACKGROUND

A search of the MEDLINE database identified many observational studies exploring the relationship between fish consumption and coronary heart disease mortality in different populations of patients. (2-7) However, no published studies were identified that explored how the measurement of red blood cell membrane omega-3 fatty acids may be used to improve patient management and health outcomes.  Specifically:

• There are no studies establishing the diagnostic parameters of omega-3 fatty acids (i.e., the definition of normal, high, and low values).
• No studies focused on how measurement of omega-3 fatty acids may be incorporated into a cardiac risk panel in patients with a prior cardiac event.
• At the present time, patients with coronary artery disease are offered the general dietary recommendation to increase fish consumption.  There are no studies addressing how this practice would be altered based on red blood cell membrane levels of omega-3 fatty acids.

REFERENCES

1. BlueCross and BlueShield Association Medical Policy Reference Manual, Policy No.2.04.40
2. He K Song Y, Daviglus ML et al. Accumulated evidence of fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation 2004;109(22):2705-11
3. Hu FB, Cho E, Rexrode KM et al. Fish and long-chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women. Circulation 2003;107(14):1852-7
4. He K, Song Y, Daviglus ML et al. Fish consumption and incidence of stroke: a meta-analysis of cohort studies. Stroke 2004;35(7):1538-42
5. Whelton SP, He J, Whelton PK et al. Meta-analysis of observational studies on fish intake and coronary heart disease. Am J Cardiol 2004;93(9):1119-23
6. Mozaffarian D, Longstreth WT, Lemaitre RN et al. Fish consumption and stroke risk in elderly individuals: the cardiovascular health study. Arch Intern Med 2005;165(2):200-6
7. Albert CM, Campos H, Stampfer MJ et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002;346(15):1113-8

Cross References

None

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