Big stud­ies give mixed news on fish oil, vi­ta­min D

The Republican Herald - - LOCAL/ NATION - By Marilynn Marchione

CHICAGO — Tak­ing fish oil or vi­ta­min D? Big stud­ies give long- awaited an­swers on who does and does not ben­e­fit from these pop­u­lar nu­tri­ents.

Fish oil taken by healthy peo­ple, at a dose found in many sup­ple­ments, showed no clear abil­ity to lower heart or cancer risks. Same for vi­ta­min D.

But higher amounts of a pu­ri­fied, pre­scrip­tion fish oil slashed heart prob­lems and heart- re­lated deaths among peo­ple with high triglyc­erides, a type of fat in the blood, and other risks for heart dis­ease. Doc­tors cheered the re­sults and said they could sug­gest a new treat­ment op­tion for hun­dreds of thou­sands of pa­tients like these.

Up to 10 per­cent of U. S. adults take fish oil. Even more take vi­ta­min D, de­spite no ma­jor stud­ies to sup­port the many health claims made for it.

“Those who ped­dle it pro­mote it as good for ev­ery­thing,” but in this de­fin­i­tive test, vi­ta­min D “showed a big noth­ing,” said Dr. James Stein, a heart spe­cial­ist at the Univer­sity of Wis­con­sinMadi­son. He had no role in the stud­ies or ties to the com­pa­nies in­volved.

Re­sults were re­vealed Satur­day at an Amer­i­can Heart As­so­ci­a­tion con­fer­ence in Chicago and pub­lished by the New Eng­land Jour­nal of Medicine.

about fish oil

These oils, also called omega- 3 fatty acids, are found in salmon, tuna and cer­tain other fish. They re­duce triglyc­erides and in­flam­ma­tion and may have other ef­fects. There are dif­fer­ent types, in­clud­ing EPA and DHA.

One study tested 4 grams a day of Amarin Corp.’ s pre­scrip­tion Vas­cepa, which is con­cen­trated EPA, in more than 8,000 pa­tients with high triglyc­erides and a greater risk of heart prob­lems for var­i­ous rea­sons. All were al­ready tak­ing a statin such as Lip­i­tor or Zo­cor to lower choles­terol. Half were given Vas­cepa and the rest, mineral oil cap­sules as a com­par­i­son.

Af­ter five years, about 17 per­cent of those on Vas­cepa had suf­fered one of these prob­lems — a heart at­tack, stroke, heart- re­lated death or clogged ar­ter­ies re­quir­ing med­i­cal care — ver­sus 22 per­cent of the oth­ers.

That worked out to a 25 per­cent re­duc­tion in risk. Looked at in­di­vid­u­ally, heart at­tacks, heart- re­lated deaths and strokes all were lower with Vas­cepa. Only 21 peo­ple would need to take Vas­cepa for five years to pre­vent one of the main prob­lems stud­ied — fa­vor­able odds, Stein said.

Side ef­fects may be a con­cern: More peo­ple on Vas­cepa were hos­pi­tal­ized for an ir­reg­u­lar heart­beat — 3 per­cent ver­sus 2 per­cent of the com­par­i­son group. Doc­tors say that’s puz­zling be­cause other re­search sug­gests fish oil low­ers that risk.

The con­cern with the heart rhythm prob­lem is that it can raise the risk of stroke, but there were fewer strokes among those on Vas­cepa, said study leader Dr. Deepak Bhatt of Brigham and Women’s Hospi­tal in Bos­ton.

A broader test

The other study tested a lower 1 gram daily dose of a dif­fer­ent type of fish oil — an EPA/ DHA combo sold as Lo­vaza or Oma­cor and in generic form — in 26,000 peo­ple with no prior heart prob­lems or cancer.

Af­ter about five years, rates of a com­bined mea­sure of heart at­tacks, strokes and other prob­lems were sim­i­lar for fish oil users and a com­par­i­son group. Cancer rates and deaths also were sim­i­lar.

There were fewer heart at­tacks in the fish oil group — 145 ver­sus 200 in the com­par­i­son group. The study

leader, Dr. Joann Man­son at Brigham and Women’s, called that “a sub­stan­tial ben­e­fit,” but sev­eral in­de­pen­dent ex­perts disag reed be­cause of the way the study was set up to track this and cer­tain other re­sults.

Fishy com­par­isons?

Both stud­ies share a prob­lem: the oils used for the com­par­i­son groups, which may not have been true place­bos. The Vas­cepa study used mineral oil, which in­ter­feres with statin drugs, raises choles­terol, and might have made the com­par­i­son group fare worse and made Vas­cepa look bet­ter than it truly was.

The other study used olive oil, which might have helped that com­par­i­son group do bet­ter, pos­si­bly mask­ing any ben­e­fit to the oth­ers from fish oil.

Lead­ers of both stud­ies say any ef­fect from the com­par­i­son oils isn’t enough to al­ter the main re­sults, and in­de­pen­dent ex­perts agreed. But Nis­sen, who is lead­ing an­other fish oil study, is us­ing corn oil as a com­par­i­son.

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