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Omega-3s Can't Enhance Heart Drug Cocktail
8/30/2010
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Unsurprising result echoes the outcome of a 2009 trial in heart patients receiving optimal drug therapy; new trial used very low doses of omega-3s 
by Craig Weatherby


The news media loves a story that runs counter to conventional wisdom… which can be a very good thing.
 
However, recent headlines about a clinical trial testing omega-3s in heart patients embody the old saying, “…never let the facts get in the way of a good headline.”
 
Dutch researchers reported that low doses of omega-3s failed to further protect heart patients who were already taking an “optimal” regimen of drugs designed to control blood pressure, cholesterol, and potential clotting.
 
But the headlines fail to say that this study does not overturn two clinically proven facts:
  • Omega-3s reduce the risk of sudden cardiac death and second heart attacks.
  • Omega-3s may not reduce these risks any further among people already taking cardiac drugs.
The scientists proposed the obvious explanation, which is that the lack of added protection from omega-3s simply reflected the combined power of the cardiac drugs... some of whose effects overlap those linked to dietary omega-3s (e.g., reduced inflammation and beneficial changes in people’s blood fat and cholesterol profiles).
 
In fact, the authors of a similar study from Germany delivered similar results just last year.
 
You will find a full review of their findings, and an overview of the overwhelmingly positive evidence in favor of omega-3s in our report, titled “Heart Patients on Drug Cocktail Showed No Extra Protection from Fish Oil.”
 
Like the findings from the current Dutch trial, the German team’s negative findings did not extend to the value of omega-3s as a longer-term preventive agent for the general public… as opposed to heart patients taking every possible drug.
 
The lead author of the 2009 German study, Jochen Senges, made this very point at the time of its release (AFP 2009):
“It would be incorrect to say that omega-3 fatty acids are not effective, but we could not find any additional benefits [within one year] after optimizing medical therapy.” 
 
Four years ago, we told a similar tale of unrealistic expectations, in “Fish Oil Can't Rescue the Sickest Cardiac Patients' Heart Rhythms.”
 
Let’s look a closer look at the trial, which unfortunately has generated many misleading headlines.
 
What the new clinical trial found
Researchers from Holland’s Wageningen University recruited 4,837 Dutch heart attack patients between the ages of 60 and 80, just over three-quarters of whom were men.
 
All had experienced a heart attack at some point during the past 10 years and had been prescribed blood pressure, anti-clotting, and statin-class drugs… a combination considered the optimal “cocktail” for these particular cardiovascular patients.
 
(Statins such as Lipitor, Pravachol, and Zocor famously lower cholesterol levels… but the evidence indicates that their anti-inflammatory effects provide equal or greater benefit to heart patients.)
 
The heart patients agreed to consume 18.8 grams of one of four different types of margarines, every day for more than three years:
  1. Added omega-3s from fish oil: DHA (150mg) + EPA (226mg)
  2. Added omega-3 ALA from seed oil (1.9gm)
  3. Added DHA (150mg), EPA (226mg), and ALA (1.9gm)
  4. No added omega-3s
The amounts of omega-3s added to the various margarines were deemed “low-dose” in relation to the doses used in successful cardiac prevention trials, and replaced equal amounts of monounsaturated fat (oleic acid) in the spread.
 
After three years, it was apparent that low doses of fish-derived omega-3s (DHA and EPA) provided no measurable added heart health protection to the heart patients in the study.
 
Nor did the Dutch study detect any added benefit from margarine containing the plant-form omega (ALA) found in leafy greens, walnuts, and a very few seed oils (canola, flax, hemp).
 
Even though the body has little or no functional use for ALA, and burns 90 to 98 percent of it for energy, only ALA – not EPA or DHA – is considered an “essential” nutrient in the human diet.
 
This is because many people have no fish or fish oil in their diet, and the body can make EPA and DHA from dietary ALA. Humans convert two to 10 percent of dietary ALA into DHA and EPA, which are the only omega-3s essential for life and overall health … especially immune and heart health.
 
By the study's end, almost 14 percent of the heart attack patients had experienced another “major cardiovascular event,” some fatal.
 
None of the low-dose omega-3 margarine regimens reduced adverse cardiac events in most of the patients.
 
The only exception was women in the omega-3 ALA margarine group, who were 27 percent less likely to develop further cardiac complications… although that reduction fell just sort of statistical significance.
 
Findings affirm the folly of excessive expectations
Cardiac physicians familiar with past research expressed little surprise at these results.
 
The strongest evidence concerning omega-3s and heart disease shows that marine-source omega-3s (EPA and DHA) protect against sudden cardiac death, which is often linked to arrhythmias among patients who have just survived a heart attack.
 
It is during this acute post-attack period that patients are most vulnerable either to a second heart attack, or to sudden cardiac death caused by an arrhythmia.
 
But the patients in this study were years past their first heart attack, and were taking the drug combination proven to help prevent heart attack or sudden cardiac death when they start taking these supplements
 
Also, the study counted not just preventable fatalities, but all heart-related adverse events, which may or may not result in death.
 
On top of that, the supplement doses they used were much lower than those used in prior, successful studies.
 
As Gregg C. Fonarow, M.D., of UCLA’s Division of Cardiology told Health Day, “It is possible that improvements in other treatments for heart attack patients have made fish oil supplementation less important for reducing cardiovascular risk. But it's also possible that the different [low] dosing used in this study relative to previous work made a difference in the outcome.”
The dosing here may have been just too low, whereas higher doses given immediately following an initial heart attack might have been protective” (HD 2010).
 
And he went on to make the obvious point: “So I would say that this is by no means the final word regarding omega-3s and cardiovascular health.”
 
 
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