Another Disappointing Study For Fish Oil Supplements

Forbes ^ | 5/08/2013 | Larry Husten

[neverdem]

Another large study has failed to find any benefits for fish oil supplements. The Italian Risk and Prevention Study, published in the New England Journal of Medicine, enrolled 12,513 people who had not had a myocardial infarction but had evidence of atherosclerosis or had multiple cardiovascular risk factors. The patients were randomized to either a fish oil supplement (1 gram daily of n-3 fatty acids) or placebo.

After 5 years of followup, the primary endpoint– the time to death from cardiovascular causes or admission to the hospital for cardiovascular causes– had occurred in 11.7% of the fish oil group versus 11.9% of the placebo group (adjusted hazard ratio 0.97, CI 0.88-1.08, p=0.58). There were no significant differences in any of the prespecified secondary endpoints.

With one exception there were no significant differences in outcome in the prespecfied subgroups. Women who received fish oil supplements had a significant reduction in the primary endpoint (HR 0.82, CI 0.67-0.99, p=0.04). The study investigators also reported that although there was no difference in the rate of hospital admissions for cardiovascular admissions, there was a significant reduction in hospital admissions for heart failure in the fish oil group (1.5% versus 2.3%, p=0.002).

Due to a lower than expected rate of events, after the first year the investigators modified the primary endpoint, which originally had been the cumulative rate of death, MI, and nonfatal stroke.

The investigators wrote that “the consistently null effect across the various end points and subgroups does not suggests alternative interpretations.” The observed benefits in women and in reducing hospital admissions for heart failure “must be considered conservatively,” they wrote.

The trial investigators discussed two previous Italian trials, the GISSI-Prevenzione trial, in MI patients, and the GISSI-HF trial, in heart failure patients, which found benefits for fish oil supplements in their respective...

[LearsFool]

SCREW “supplements”! If you want the benefits of eating fish... eat FISH.

What're you trying to do, put the pill makers out of business??

/s

[jdege]

“Of course, it isn’t just “fish oil” - it is the Omega 3s”

There’s a world of difference between whole Omega 3s and Omega 3s that have oxidized - gone rancid.

If you’re finding yourself burping fishy smells, you can be sure that your fish oil tablets have gone rancid - and rancid oils not only aren’t protective, they make things worse.

And it wouldn’t take a very large proportion of the study participants to have been taking fish oil pills that had gone rancid to mask whatever benefit that the non-rancid pills were providing.

[Labyrinthos]

The Italian Risk and Prevention Study, published in the New England Journal of Medicine, enrolled 12,513 people who had not had a myocardial infarction but had evidence of atherosclerosis or had multiple cardiovascular risk factors.

In other words, if you already have heart disease or if you're a fat, lazy, chain-smoking, junk-food addicted, couch potato, then all the fish oil in the world isn't going to save your sorry a$$.

[csmusaret]

The patients were randomized to either a fish oil supplement (1 gram daily of n-3 fatty acids) or placebo.

No wonder it didn’t work. I’d like to see the study repeated with 3 grams per day. I reduced my cholesterol from 220 to 185 by taking 3 of these a day....http://www.swansonvitamins.com/swanson-efas-multiomega-3-6-9-flax-borage-fish-1200-mg-240-sgels?otherSize=SWE020

[poobear]

Hey neverdem, I take fish oil supplements along with a healthy diet and exercise and my good cholesterol is 121! I’m a freak of nature I guess.

[kruss3]

hemorrhagic stroke is a legitimate issue. I believe that you offset that specific risk by significantly reducing the incidence of ischemic stroke with omega 3 or aspirin. Atherosclerosis. 2012 Dec;225(2):291-5. doi: 10.1016/j.atherosclerosis.2012.09.006. Epub 2012 Sep 18. Omega-3 fatty acids: benefits for cardio-cerebro-vascular diseases. Siegel G, Ermilov E. Source Charité - University Clinic Berlin, D-14195 Berlin, Germany. guenter.siegel@charite.de Abstract BACKGROUND AND PURPOSE: Intracranial artery stenosis (ICAS) is a narrowing of an intracranial artery, which is a common etiology for ischemic stroke. In this commentary, we review key aspects of the discrimination between non-stroke controls and ischemic stroke patients on the background of phospholipid ω3-fatty acid (DHA, EPA) composition. The discussion is embedded in the presentation of general effects of long-chain ω3 polyunsaturated fatty acids (PUFAs) in cardio-cerebro-vascular diseases (CCVDs) and Alzheimer dementia (AD). SUMMARY OF COMMENTARY: ICAS is a common stroke subtype and has emerged as a major factor in recurrent stroke and vascular mortality. DHA and EPA are important fatty acids to distinguish between NCAS (no cerebral arteriosclerotic stenosis) and ICAS in stroke. The risk of ICAS is inversely correlated with the DHA content in phospholipids. Furthermore, a mechanistic explanation has been proposed for the beneficial effects of PUFAs in CCVDs and AD. CONCLUSIONS: Whereas the beneficial effects of EPA/DHA for cardiovascular diseases and stroke seem to be beyond question, preventive effects in patients with very mild cognitive dysfunction and beginning Alzheimer's disease undoubtedly need confirmation by larger clinical trials. A collaborative international basic science approach is warranted considering cautiously designed studies in order to avoid ethical problems. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved. Am Heart J. 2013 Feb;165(2):208-15.e4. doi: 10.1016/j.ahj.2012.10.021. Epub 2013 Jan 4. Plasma n-3 polyunsaturated fatty acids in chronic heart failure in the GISSI-Heart Failure Trial: relation with fish intake, circulating biomarkers, and mortality. Masson S, Marchioli R, Mozaffarian D, Bernasconi R, Milani V, Dragani L, Tacconi M, Marfisi RM, Borgese L, Cirrincione V, Febo O, Nicolis E, Maggioni AP, Tognoni G, Tavazzi L, Latini R. Source Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy. Abstract Treatment with long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) can improve clinical outcomes in patients with heart failure (HF). Circulating levels of n-3 PUFA, an objective estimation of exposure, have never been measured in a large cohort of patients with HF. METHODS: We measured n-3 PUFA in plasma phospholipids at baseline and after 3 months in 1,203 patients with chronic HF enrolled in the GISSI-Heart Failure trial and randomized to n-3 PUFA 1 g/daily or placebo. N-3 PUFA levels were related to clinical characteristics, pharmacologic treatments, dietary habits, circulating biomarkers, and mortality. RESULTS: Baseline n-3 PUFA (5.1 ± 1.8 mol%) was associated with dietary fish intake, with an average difference of 43% between patients with the lowest and highest consumptions (P < .0001). Baseline eicosapentaenoic acid (EPA) but not docosahexaenoic acid (DHA) was inversely related to C-reactive protein, pentraxin-3, adiponectin, natriuretic peptide, and troponin levels. Three-month treatment with n-3 PUFA raised their levels by 43%, independently of dietary fish consumption; increases in EPA levels were associated with decreased pentraxin-3. Low baseline levels of EPA but not DHA were no longer related to higher mortality after the addition of circulating biomarkers to multivariable models. CONCLUSION: Before supplementation, circulating n-3 PUFA levels in patients with chronic HF mainly depend on dietary fish consumption and are inversely related to inflammatory markers and disease severity. Three-month treatment with n-3 PUFA markedly enriched circulating EPA and DHA, independently of fish intake, and lowered pentraxin-3. Low EPA levels are inversely related to total mortality in patients with chronic HF. Copyright © 2013 Mosby, Inc. All rights reserved. Kardiologiia. 2012;52(12):17-23. [Influence of ω-3 PUFAs on predictors of sudden cardiac death in patients with Q-wave myocardial infarction]. [Article in Russian] Logacheva IV, Barantseva NG, Vinokurova ES. Abstract OBJECTIVE: To assess effect of ω-3 polyunsaturated fatty acids (PUFAs) on non-invasive predictors of sudden cardiac death (ventricular arrhythmias, QT duration and variability, late ventricular potentials [LVP], microvolt-level T-wave alternans [MTWA], and heart rhythm turbulence [HRT]) in patients with Q-wave myocardial infarction (MI) and ventricular heart rhythm disturbances (VHRD). MATERIAL AND METHODS: The study included 140 men aged 52.5+/-1.3 years with primary diagnosis of Q-wave MI and I-IV Lown grade VHRD. Patients were randomized in 2 groups: index group (A) and control group (B) consisted of 70 persons each. Patients of index and control groups were divided into another 2 groups by severity of arrhythmic syndrome: Al (n=39) and Bl (n=38) with I-III grade VHRDs; A2 (n=31) and B2 (n=32) with IV-V grade VHRDs. In index groups (Al and A2) ω-3 PUFA medicine was administered additionally to standard therapy at a dose of 1 g/day during 6 months. All patients underwent standard clinical examination and 24-hour Holter ECG monitoring on days 10-14 and in 6 months after MI. RESULTS: Decreases of single and paired ventricular extrasystoles, ventricular tachycardia runs, total duration of myocardial ischemia were observed in patients of index groups Al and A2 after ω-3 PUFAs treatment. After 6 months of ω-3 PUFAs treatment significant QT shortening and increase of QTc variability were noted. Numbers of patients with LVP in Al and A2 groups decreased 21.3% (p<0.05) and 38.7% (p<0.0l), with HRT - 20.5% and 29.1% (p<0.05), with MTWA - 18% and 16.1% (p<0.01). In control groups the result was statistically insignificant. CONCLUSION: Administration of 1 g/day of a prescription preparation of 90% ω-3 PUFAs in patients with primary Q-wave MI was associated with decrease of ventricular ectopy severity in patients with low and high grade VHRD and simultaneous reduction of total myocardial ischemia time. ω-3 PUFAs administration for 6 months had marked positive effect on QT duration and variability, LVP, HRT, MTWA. PMID: 23237436 [PubMed - indexed for MEDLINE] Br J Nutr. 2012 Jun;107 Suppl 2:S201-13. doi: 10.1017/S0007114512001596. Long chain omega-3 fatty acids and cardiovascular disease: a systematic review. Delgado-Lista J, Perez-Martinez P, Lopez-Miranda J, Perez-Jimenez F. Source Lipids and Atherosclerosis Unit, Department of Medicine, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Cordoba, Cordoba, Spain. Abstract Introduction: Cardiovascular disease remains the commonest health problem in developed countries, and residual risk after implementing all current therapies is still high. The use of marine omega-3 fatty acids (DHA and EPA) has been recommended to reduce cardiovascular risk by multiple mechanisms. Objectives: To update the current evidence on the influence of omega-3 on the rate of cardiovascular events. Review Methods: We used the MEDLINE and EMBASE databases to identify clinical trials and randomized controlled trials of omega-3 fatty acids (with quantified quantities) either in capsules or in dietary intake, compared to placebo or usual diet, equal to or longer than 6 months, and written in English. The primary outcome was a cardiovascular event of any kind and secondary outcomes were all-cause mortality, cardiac death and coronary events. We used RevMan 5·1 (Mantel-Haenszel method). Heterogeneity was assessed by the I2 and Chi2 tests. We included 21 of the 452 pre-selected studies. Results: We found an overall decrease of risk of suffering a cardiovascular event of any kind of 10 % (OR 0·90; [0·85-0·96], p = 0·001), a 9 % decrease of risk of cardiac death (OR 0·91; [0·83-0·99]; p = 0·03), a decrease of coronary events (fatal and non-fatal) of 18 % (OR 0·82; [0·75-0·90]; p < 1 × 10⁻⁴), and a trend to lower total mortality (5 % reduction of risk; OR 0·95; [0·89-1·02]; p = 0·15. Most of the studies analyzed included persons with high cardiovascular risk. Conclusions: marine omega-3 fatty acids are effective in preventing cardiovascular events, cardiac death and coronary events, especially in persons with high cardiovascular risk. PMID: 22591894 [PubMed - indexed for MEDLINE]

[steve86]

Yes, ischemic stroke prevention is a proven benefit of Omega-3. Keep the dose at 3g or below and avoid the increased incidence of the other. No need to “offset”: it hasn’t increased yet (to the best of my knowledge). No, I’m not reading beyond the first sentence of that!

[imardmd1]

I forgot to mention that I had heard that fish oil helps prevent colds and flu.
(1) I have not accepted flu shots for many years.
(2) Since taking fish oil for 2 years, I have had no colds or flu experiences.
FWIW

[neverdem]

n–3 Fatty Acids in Patients with Multiple Cardiovascular Risk Factors

BACKGROUND
Trials have shown a beneficial effect of n−3 polyunsaturated fatty acids in patients with a previous myocardial infarction or heart failure. We evaluated the potential benefit of such therapy in patients with multiple cardiovascular risk factors or atherosclerotic vascular disease who had not had a myocardial infarction.

METHODS
In this double-blind, placebo-controlled clinical trial, we enrolled a cohort of patients who were followed by a network of 860 general practitioners in Italy. Eligible patients were men and women with multiple cardiovascular risk factors or atherosclerotic vascular disease but not myocardial infarction. Patients were randomly assigned to n−3 fatty acids (1 g daily) or placebo (olive oil). The initially specified primary end point was the cumulative rate of death, nonfatal myocardial infarction, and nonfatal stroke. At 1 year, after the event rate was found to be lower than anticipated, the primary end point was revised as time to death from cardiovascular causes or admission to the hospital for cardiovascular causes.

RESULTS
Of the 12,513 patients enrolled, 6244 were randomly assigned to n−3 fatty acids and 6269 to placebo. With a median of 5 years of follow-up, the primary end point occurred in 1478 of 12,505 patients included in the analysis (11.8%), of whom 733 of 6239 (11.7%) had received n−3 fatty acids and 745 of 6266 (11.9%) had received placebo (adjusted hazard ratio with n−3 fatty acids, 0.97; 95% confidence interval, 0.88 to 1.08; P=0.58). The same null results were observed for all the secondary end points.

CONCLUSIONS
In a large general-practice cohort of patients with multiple cardiovascular risk factors, daily treatment with n−3 fatty acids did not reduce cardiovascular mortality and morbidity. (Funded by Società Prodotti Antibiotici and others; ClinicalTrials.gov number, NCT00317707.)

So the placebo is a variant of the Mediterranean diet which is high in n−3 Polyunsaturated Fatty Acids. For some reason I didn't check the abstract before I posted the article from Forbes which linked the abstract.

P.S. If a story links the original citation or its abstract, then I don't.

[imardmd1]

Thanks!

[Magic Fingers]

“This study was designed for the purpose of showing no effect: the dosage was too small...”

A popular technique...also recently used to “prove” that Vitamin D supplements are of no value.

[imardmd1]

It came to mind that in my professional days, I ran across a fish oil that was used as a surfactant, and thought that maybe it has a medical or supplement use. Browsing gave me this:

Menhaden Fish Oil Product w/claims

Found---The Missing Link in Omega-3 Nutrition: Super DPA from Menhaden Fish Oil

"... EPA and DHA fatty acids are among the most documented in nutrition research. However, a third key fatty acid, docosapentaenoic acid—DPA—has been shown to play probably the most powerful role in key health outcomes. DPA is an elongated version of EPA and has drawn the attention of scientists because it is present in relatively high levels in the diets of the Greenland Inuit people, a population group with exceptional cardiovascular health."

(This is an advertisement site, but maybe has some meaning as a supplement to look into??)

[neverdem]

Thanks for the link.

[rmlew]

But olive oil had its own health benefits. It is is a horrible placebo.

[neverdem]

But olive oil had its own health benefits. It is is a horrible placebo.

That was my point. How did this get in the New England Journal of Medicine, and how did Larry Husten, "a medical journalist covering cardiology news" blow it? I have to wonder about it. Does anyone check the links besides me? What if I croaked before I posted the abstract?

[kruss3]

Hey imardmd1,

Your DHP post may be be the missing insight that alters the course of civilizations. Mega Kudos to you.

[kruss3]

Hey imardmd1,

Your DHP post may be be the missing insight that alters the course of civilizations. Mega Kudos to you.

[imardmd1]

Awww, shucks! -- just a cognitive mild dysfunction, ya know --

(From your #46, ... Whereas the beneficial effects of EPA/DHA for cardiovascular diseases and stroke seem to be beyond question, preventive effects in patients with very mild cognitive dysfunction and beginning Alzheimer's disease undoubtedly need confirmation by larger clinical trials. A collaborative international basic science approach is warranted considering cautiously designed studies in order to avoid ethical problems.")

Like the studies conducted for the claims on DPA ? (/sarc)

I have a friend who is a missionary to the Greenland Inuits, who said their idea of a sumptuous meal is sitting down to a large block of fresh-cut seal blubber. Fact. No /sarc.

(/gag)

[Salvation]

Or is this big pharma wanting to keep us away from natural aids to health?

I don’t trust it.

[Salvation]

BTTT!