For some heart patients, fish oil has a role to play

Dear Dr. Roach: I have heard that fish oil can clog the arteries and cause problems, but I’ve also heard it’s good to take. I don’t know if it is good or bad. Can you help me out with this?

G.G.

There remains controversy about fish oil, but recent studies prompted the U.S. Food and Drug Administration advisory committee to recommend wider use of a prescription fish oil. These new studies showed that icosapent ethyl (Vascepa), a highly purified fish oil ester, reduced the risk of cardiovascular events by five per cent, and lowered the risk of cardiovascular death by 0.9 per cent in people with high triglycerides, known coronary artery disease, diabetes and at least one other risk factor despite the use of statin drugs. However, there are several important cautions.

The first is that this is a high-risk group, and the results of this study cannot be applied to people who do not have these risk factors. The second is that two potential side-effects (bleeding and abnormal heart rhythms, especially atrial fibrillation) were seen at higher rates in those who took the fish-oil drug. The third is that this drug does not take the place of statins, which have been far better studied and in different populations. Finally, this drug is highly purified and subject to intense regulation. There are very good reasons to think that the prescription version of this drug has different effects on the body than omega-3 supplements you can buy at the pharmacy or health food store.

For people with higher-than-average risk of heart disease and high triglycerides despite statin therapy, I believe fish oil, or fish oil-based pharmaceuticals, have a role to play in reducing the risk of heart attack, stroke and death that will be further revealed in the next few years.

Dear Dr. Roach: I’m well aware of the benefits of a good exercise regime, but I have run across something that interests me. Being of an age when replacement parts — knees, hips, shoulders etc. — are becoming the norm among my friends, I’ve noticed that those with the most vigorous exercise programs prior to surgery seem to have more post-operative problems than those with something more moderate. Is this a problem of muscles being too strong, or is it just a coincidence?

V.V.M.

Many people believe that exercise causes arthritis, but it seems to be injury that causes arthritis. Regular, moderate exercise appears to be beneficial to the joints.

It is true that injury can be caused by overly vigorous exercise, especially exercises that involve a great deal of sudden stress and especially in people who have not taken the time to gain muscular strength. This strength helps joints remain stable and tends to prevent excess trauma to the joint. While regular exercise does not prevent the development of osteoarthritis (the reason for 90 per cent or more of joint replacements now), exercise certainly improves function and reduces pain.

My experience is that people who were fitter before joint replacement surgery tend to do better than people who weren’t. Perhaps some of your friends with aggressive prior exercise regimens were impatient and may have attempted to overdo movements of their joints when they should have been recovering. Having had many patients go through joint replacements, the ones who have done the best are the ones who most closely adhere to their therapist’s (and their surgeon’s) instructions and advice.