Omega-3 Lowers Major Cardio Events in Patients with Previous Heart Attack
Simone, R.B.M. et al., European Heart Journal, 33: 1582-1588, 2012
Utrecht Institute for Pharmaceutical Sciences , Utrecht University, Utrecht, The Netherlands
In patients having suffered a previous myocardial infarction (heart attack), some major trials have shown considerable protection against subsequent cardiovascular events by adding DHA/ EPA omega-3 supplementation onto conventional medical treatment while a few recent trials have not. Thus, the present study (using patients from the Alpha Omega Trial) was designed to determine if medication with or without cholesterol-lowering statin drugs in such patients may influence the cardio-protective effects of DHA/EPA supplementation. It is recalled that the Alpha Omega Trial included post-myocardial infarction patients (both statin-users and non- statin users) wherein it was reported by this group that intervention with a margarine enriched in omega-3 fatty acids did not reduce subsequent cardiovascular events (New Engl, J. Med., 363: 2015-2026 (2010).
For the present purpose, the patients from the Alpha Omega Trial (the vast majority of whom were on anti-hypertensive and anti-thrombotic medications) were divided into those on cholesterol-lowering statin therapy and those who were not. The two groups (‘statin users’ and ‘non-statin users’) were assigned to one of four daily margarine treatments : controls with no omega-3, 400 mg of EPA plus DHA, 2 grams of ALA (alpha-linolenic acid) , or a combination of 400 mg of EPA/DHA plus ALA. The 4837 patients (ages 60-80 yrs) were followed for 41 months.
In the ‘statin users’, omega-3 did not reduce major cardiovascular events (incl. fatal cardiac events, non-fatal heart attacks and strokes, need for cardio surgery). However, a significant benefit of omega-3 treatment was found in the ‘non-statin users’ such that 18 % of those on the ‘placebo’ margarine suffered a serious cardio event as compared to only 9 % of those on the omega-3 margarine (EPA plus DHA plus ALA). The authors concluded that ‘In patients with a history of MI who are not treated with statins, low-dose supplementation with n-3 fatty acids may reduce major cardiovascular events.’
These findings are of interest in that the background medication regimen (in this case – with or without statins) influenced the potential cardio-protective effects of omega-3 fatty acids. It is also of interest to note that the group showing the benefit of omega-3 intervention (‘non-statin users’) tended to have higher levels of total blood cholesterol and LDL-cholesterol than the other patients at the beginning of the study. Thus, the omega-3 benefits appear to be mediated independent of blood cholesterol-lowering mechanisms as is well established in the literature (Holub , Can. Medical Assoc. J. , 16: 608-615 (2002)). It remains to be determined whether the use of statin medications may possibly interact in some ways with the efficacy of the cardio benefits of omega-3 fatty acids. It is also noteworthy that the Dutch patients in this study were averaging just over one fish serving/week in their background diet with just over 30 % of them approaching two servings/week. It is not known if the benefits observed with omega-3 in the ‘non-statin users’ may have been of differing magnitudes depending upon the background dietary intake of fish and EPA/DHA.