Giving Fish Oil a Miss

 Fish oil supplements as well as another omega-3 fatty acid found in plants don't help people who've had a heart attack avoid another, nor stabilize an increasingly common condition called atrial fibrillation, two studies reported at this week's American Heart Association meeting and published in the New England Journal of Medicine and the Journal of the American Medical Association, respectively, conclude.

Wow.  How's that for a sentence?  Beyond that, how's that for a conclusion?  It flies in the face of current practice in many European countries and even right here at home, where people who've had a myocardial infarction or heart attack are routinely prescribed fish oil to stave off another.  It's been going on for years, but this NEJM study handily dispatches with the purported benefit of the supplement. 

Almost 5000 people aged 60 through 80 who had had a myocardial infarction, the majority of whom were men, were randomized to receive 40 months of fish oils or placebo.  These people were already on medications to modify lipids, control high blood pressure and prevent clot formation, known as 'very good medical therapy.'  Ah, and there's the rub, Rick opines in this week's podcast.  After this admittedly extensive follow-up, those who were taking the supplements did not experience a reduced rate of major cardiovascular events compared with those who were on placebo.  Voila!  Yet one more supplement to consign to the give it a miss category.

The rub really centers on 'very good medical therapy,' something I strongly advocate.  When what is known in medicine as the constellation of risk factors for heart disease are modified, other factors, such as fish oils, become less important.  That's Rick's interpretation of the results.  I am persuaded that if all the other risk factors such as smoking status, body weight, and exercise were added to the equation fish oil would cease to be the big seller it is right now.

Atrial fibrillation (AF), the condition where the upper chambers of our four-chambered heart don't quite synch up with the rest of the organ, resulting in a quivering sensation and a propensity for clot formation, isn't relieved by another type of omega-3 fatty acid, the JAMA study concludes.  Almost 700 people with AF were randomized to receive an omega-3 or placebo.  After 24 weeks of follow-up, no benefit was seen in the supplement group. How disappointing.

With regard to AF, looks like we're back to the drawing board, but as far as preventing a second heart attack goes, we're on to something.  Just as has been shown in other heart conditions, very good medical therapy helps.

Other topics this week include the FDA's action against manufacturers of alcohol and caffeine containing beverages, the very costly issue of prescription abandonment in this issue of Annals of Internal Medicine, and destroying nerves to the kidneys to control very high blood pressure in the Lancet.  Until next week, y'all live well.

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fish oils November 27, 2010 at 5:33 am

I am persuaded that if all the other risk factors such as smoking status, body weight, and exercise were added to the equation fish oil would cease to be the big seller it is right now.

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