Fish oil for heart health? A tale of two studies
February 28, 2019
Two conflicting clinical studies have added more fuel to the ongoing debate surrounding fish oil: Can omega-3 fatty acid supplements reduce a patient’s risk of heart attack?
A March 2018 meta-analysis published in JAMA Cardiology appeared to validate the general consensus within the medical community that fish oil is ineffective for most patients. The study, which was mentioned in The New York Times, included data from 10 clinical studies of nearly 78,000 older adults with high risk of cardiovascular disease. This research suggests that fish oil did not provide significant protection against major vascular events among any subgroup of participants.
However, the November 2018 REDUCE-IT trial, published in The New England Journal of Medicine, was the first large clinical trial to suggest that a particular type of omega-3 fatty acid could reduce the risk of ischemic events compared to placebo in patients with high triglyceride levels.
These conflicting findings, paired with a sea of misinformation online, emphasize the importance of open communication between patients and doctors. Only when we stack scientific facts against a patient’s individual needs can we reduce the risk for heart attacks.
In general, about half of patients’ heart disease risk can be attributed to genetic factors that are passed down through families. While these factors can’t be prevented, patients and doctors can work together to reduce associated risks and manage the conditions.
The other half of heart disease risk can be directly attributed to patients’ lifestyles and co-morbidities. The foods we eat and our daily activities shape the trajectory of our heart health from infancy through adulthood. High blood pressure, high cholesterol, and diabetes all contribute importantly to cardiovascular disease risk. Creating heart-healthy strategies based on patients’ genetics, disease conditions, and lifestyle can greatly reduce heart attack risk.
“People trust aeronautical science when we board airplanes. We trust mechanical engineering when we cross bridges. But, unfortunately, some patients do not accept legitimate scientific research when it comes to their health.”
As such, personalization of care was emphasized in the November 2018 cholesterol guidelines, which were issued by the American Heart Association and the American College of Cardiology. Doctors can help patients develop personalized care plans by having honest, open conversations, starting with three overarching topics.
1. Eat a heart-healthy diet
Eating fatty fish such as salmon, mackerel, and tuna a few times a week is part of the heart-healthy Mediterranean diet. Sadly, squeezing the nutritional attributes of fish into a pill or supplement will not work the same way. Just as there is no “exercise pill,” there is no “healthy diet” pill that makes heart-healthy eating easier.
2. Know your numbers
It is important for patients to familiarize themselves with their numbers for weight, cholesterol, and blood pressure, as well as what is considered healthy and optimal for their age and overall health.
Eating a healthy diet, exercising 30 or more minutes daily, and avoiding smoking and tobacco use are key strategies to keeping numbers in a healthy range. A doctor can help patients develop a plan to manage their numbers long-term.
3. Believe in science, not Dr. Google
The health sciences have more skepticism stacked against them than many other fields of study. People trust aeronautical science when we board airplanes. We trust mechanical engineering when we cross bridges. But, unfortunately, some patients do not accept legitimate scientific research when it comes to their health. Instead, they believe false information about anything from vaccines to statins that is published by organizations and people with financial and personal agendas – or who are simply misinformed.
Health care science is sound, and the therapies we prescribe are rigorously tested with the best interests of our patients in mind. A patient should feel comfortable knowing that a doctor wants what is best for his or her health. If not, it is time to find a different physician.
Related reading: 10 truths about statins and high cholesterol
A few final thoughts
Science is constantly evolving. Today, the jury is still out when it comes to whether fish oil supplements can reduce the risk of cardiovascular disease. We need to conduct further clinical studies before we can either rule out their use or make a case for prescribing them in certain circumstances.
For example, the placebo used in the REDUCE-IT trial contained mineral oil, which might have interfered with medicine absorption and other body processes in participants, leaving the question of whether the fish oil really helped, or the mineral oil elicited unintended results. Ongoing studies of fish oil supplements, including the international STRENGTH trial led locally at UT Southwestern by Parag Joshi, M.D., are using corn oil in the placebo pill, which most scientists agree will not affect trial outcomes. We are hopeful that the STRENGTH trial will help validate the findings from the REDUCE-IT trial and shed light on how and in whom fish oil may be beneficial.
In my practice, I recommend care based on science. To date, the data have shown time and again that personalized therapies with proven treatments and open communication give patients the best chance at healthier hearts.