By James H. O’Keefe, M.D., and William S. Harris, Ph.D.
Many people who had been taking omega-3 in the past stopped taking it after some negative publicity in recent years suggested no benefit for fish oil. Unfortunately, modern medicine tends to dismiss nutritional therapies as worthless, preferring instead to favor therapies such as prescription drugs, implantable devices, invasive procedures and surgeries.
Now a groundbreaking study has confirmed the longstanding strategy of using omega-3 (fish oil) in combination with a statin to lower the risk of cardiovascular disease. The REDUCE-IT Trial enrolled 8,179 patients with heart disease or diabetes who were already on a statin drug. They also had mild-to-moderately elevated triglycerides (150 to 500 mg/dL; 216 on average). After being enrolled in the study, they were randomly assigned to take either four capsules per day of a highly concentrated omega-3 product (icosapent ethyl) or placebo.
This landmark study showed that high-dose omega-3 caused a 25 percent reduction in major adverse events like heart attack, stroke and cardiovascular death. Remember, this is on top of the 25 percent reduction in cardiovascular risk that the statins were already providing to these patients.
The key reason why this most recent study showed omega-3 to be effective when others have not, relates to dose: in REDUCE-IT, 4 grams per day of omega-3 was given; whereas in the others, less than 1 gram was given.
Another recent omega-3 study deserves comment. The ASCEND Trial was a seven-year, placebo-controlled study of 15,400 diabetic patients that was recently published in the New England Journal of Medicine. The authors concluded: “There was no significant difference in the risk of serious vascular events between those who were assigned to receive omega−3 supplementation and those who were assigned to receive placebo.” Admittedly, the primary endpoint—risk of heart attack, stroke or vascular death—was just 3 percent lower in the fish oil group, and this did not meet statistical significance.
However, omega-3 did reduce vascular death by 19 percent, which was in fact statistically significant. Strangely, this important benefit, which was conferred by a single 1-gram capsule a day of a high-potency omega-3 that provided about 840 mg of EPA + DHA, was largely dismissed. The authors stated that their findings “do not support the current recommendations for routine dietary supplementation with omega−3 fatty acids to prevent vascular events.” We would take exception this conclusion, because the omega-3s clearly provided an important benefit.
In May 2018, the American Heart Association (AHA) released a scientific advisory on the benefits of eating fish. The initial AHA advisory on this topic was released 16 years ago (and Dr. Harris, a co-author of this article, was a co-author of that advisory). In the updated statement, the AHA doubled down on its recommendation to increase intake of omega-3, preferably as one to two meals of non-fried fish or shellfish per week.
Past research shows that omega-3 oils from fish and seafood benefit the heart in many ways, by decreasing the risk of abnormal heart rhythms that can lead to sudden death, reducing triglyceride levels and slowing the growth of fatty plaques that clog arteries.
Fish rich in omega-3 include salmon, herring, trout, sardines and albacore tuna. Cod, catfish, tilapia, scallops, lobster, mussels, and shrimp still contain omega-3s, but not in high amounts. Unfortunately, about 90 percent of Americans do not consume the recommended amount of fish and/or omega-3.
Tens of thousands of studies over the past three decades have proven that omega-3 supplements not only reduce the risk of cardiovascular death, but they can also be helpful for burning off belly fat, maintaining muscle mass, decreasing muscle pain after exercise, preventing brain shrinkage with age, boosting mood, building strong bones, and reducing inflammation in the brain and body.
Bottom line, omega-3 is a very safe, natural and effective way to improve cardiovascular health; after all this is essentially a food. It’s simply the fat from fish.
Dr. O’Keefe is a cardiologist with Saint Luke’s Cardiovascular Consultants, located in Lee’s Summit at 20 N.E. Saint Luke’s Blvd., Suite 110, 816-931-1883. Also read Dr. O’Keefe’s newsletter, From the Heart, online visit: http://www.saintlukeshealthsystem.org/saint-lukes-cardiovascular-consultants-newsletter.