FISH-OIL FAQS AN­SWERED To help un­der­stand find­ings of ma­jor heart study pre­sented last week­end in Chicago, doc­tors weigh in on key ques­tions

Chicago Sun-Times (Sunday) - - TOP NEWS - BY EMILY MCTAV­ISH, STAFF RE­PORTER em­c­[email protected]­times.com | @EmMcT

Pre­scrip­tion fish-oil pills have now been shown to have a pos­si­ble heart ben­e­fit, as study re­sults pre­sented last week­end in Chicago at the Amer­i­can Heart As­so­ci­a­tion’s an­nual sci­en­tific con­fer­ence showed.

But how can you know whether this is some­thing for you?

In one trial, heart patients al­ready on a statin, like Lip­i­tor or Zo­cor, took four grams a day of Vas­cepa — con­cen­trated EPA, an omega-3 fatty acid from fish oil. The study found a 25 per­cent risk re­duc­tion in car­diac events.

The other study in­volved a lower dose — one gram — of two omega-3s, an EPA-DHA combo sold as Lo­vaza or Oma­cor. It was taken by peo­ple with no past heart prob­lems. The study found fewer heart at­tacks among those tak­ing the fish-oil pill — “a sub­stan­tial ben­e­fit,” ac­cord­ing to the study’s leader, though other ex­perts ques­tioned how the study was done.

To help un­der­stand the find­ings and who could ben­e­fit, we spoke with three Chicago heart spe­cial­ists: Dr. Mark Huff­man, a car­di­ol­o­gist at the Bluhm Car­dio­vas­cu­lar In­sti­tute at Northwestern Me­mo­rial Hos­pi­tal, Dr. Khaled Dajani, an as­so­ciate pro­fes­sor of car­di­ol­ogy at Loy­ola Univer­sity Med­i­cal Cen­ter in May­wood, and Dr. Michael David­son, the Univer­sity of Chicago Medicine’s di­rec­tor of pre­ven­tive car­di­ol­ogy.

Q: Are th­ese avail­able?

A: Yes. The fed­eral Food and Drug Ad­min­is­tra­tion al­ready has ap­proved them for some patients, though it’s ex­pected that they might be­come more widely pre­scribed now, with the study re­sults ap­pear­ing, with some caveats, pos­i­tive. What’s the cost?

About $280 a month. Many in­sur­ance plans cover them. More now might.

Q: How can you find out whether ei­ther drug would be ap­pro­pri­ate for you?

Al­ways start by talk­ing with your doc­tor.

The [Lo­vaza] trial re­ally in­cluded dif­fer­ent pa­tient pop­u­la­tions. [The Vas­cepa trial was] largely peo­ple who had a prior car­dio­vas­cu­lar event. So th­ese are peo­ple who had a heart at­tack be­fore. Peo­ple that have had this pre­vi­ous car­dio­vas­cu­lar are in­her­ently at a higher risk for de­vel­op­ing a sub­se­quent car­dio­vas­cu­lar event.

The sec­ond im­por­tant dif­fer­ence is that th­ese two in­ter­ven­tions, while seem­ingly very sim­i­lar fish oil, were ac­tu­ally pretty dif­fer­ent. I think it’s th­ese dif­fer­ences that seem to be of an im­por­tant po­ten­tial driver of the re­sults. We’re still try­ing to un­pack the data in all its de­tail.

Q: Is a doc­tor likely to pre­scribe this for some­one who doesn’t have high triglyc­erides but has other high risks for car­dio­vas­cu­lar dis­ease?

“I had a dis­cus­sion with one of my patients this morn­ing — who did not have a par­tic­u­larly el­e­vated triglyc­eride level — about the po­ten­tial role for Ves­cepa for him.

“The pa­tient hasn’t had a re­cur­ring myocardial in­farc­tion, or heart at­tack, in more than 20 years. So he’s de­clared him­self to be some­what dif­fer­ent than the patients in this trial.

“For this pa­tient, both he and I thought that he wouldn’t be an ideal can­di­date. Even for patients that fit the ex­act in­clu­sion cri­te­ria — like any in­ter­ven­tion that we pro­vide in the of­fice for our patients — we have a con­ver­sa­tion about risks, ben­e­fits and al­ter­na­tives.

Q: Could I just take more of the fish-oil sup­ple­ments you can buy with­out a pre­scrip­tion at a drug­store?

“I would def­i­nitely not do that be­cause the 20 cap­sules a day not only gives you a com­pa­ra­ble amount but also other stuff you don’t want — like un­nec­es­sary calo­ries, other oils that are not pro­tec­tive and maybe other things that are in the sup­ple­ments that don’t have the same rigor when it comes to pre­scrip­tion prod­ucts. I would cau­tion against try­ing to match the amount of omega-3s with di­etary sup­ple­ments.”

Q: Can you go to your own doc­tor about this?

“It’s a dis­cus­sion to have with their pri­mary care doc­tor. And maybe a spe­cial­ist may have more de­tails about it. Cer­tainly, it’s some­thing they could talk about it with their doc­tor and see where it goes from there.”

Q: Are th­ese drugs some­thing that you would rec­om­mend for some­one in your own fam­ily?

“I would rec­om­mend it now. I’ve been an omega-3 re­searcher for over 30 years. So I be­lieve in the hy­poth­e­sis that high doses of omega-3s can make a dif­fer­ence for heart dis­ease. I’m in the camp that is en­thu­si­as­tic for this ap­proach.

I think that we need to see more re­search done. This was one study. I think this is a good study. But I would wait for other stud­ies be­fore wide­spread use.

Q: What hap­pens if a pa­tient stops us­ing the drugs?

Once you stop the drug, the ben­e­fits stop, too. There may be some legacy ben­e­fits, but that’s not yet clear. It should be con­sid­ered a life­time ther­apy.”

AMARIN CORP.

Dr. Mark Huff­man One of the pre­scrip­tion fish-oil pills, Vas­cepa.

Dr. Michael David­son

Dr. Khaled Dajani

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