Healthy Living: November 13, 2018

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BANGOR, Maine (WABI) - This past Saturday at a conference of the American Heart Association in Chicago researchers announced the results of 2 large studies looking at who does and who might not benefit from commonly used supplements to lower cardiovascular risks. First the bad news: Fish oil and Vitamin D taken by healthy people at doses found in many over-the-counter supplements apparently did not show any clear health benefits. However, the good news is that for those at higher risk due to elevated triglycerides the use of prescription medicines can be associated with a lower risk of heart attacks and strokes, albeit at a cost.

More specifically, the first study compared the use of the drug Vascepa with that of a mineral oil placebo for 8,000 pts over a 5 year interval. Their findings as reported by the New England Journal of Medicine and the Associated Press, demonstrated a decreased risk of heart-related deaths and strokes. Analysis of the NNT data (how many pts are 'needed to treat') showed that only 21 people would need to take the medicine for five years to see one of these benefits, which is favorable when compared with other NNT statistics for many medical interventions The monthly average cost of $280 for this medication is a concern for many who may not have insurance, however. A five year's expense for this medication would approach $17,000.

The second study looked at an older drug, marketed as Lovaza or Omacor, and showed less dramatic benefits with fewer heart attacks, but experts were divided on the implications. Because the placebo group was given olive oil instead of mineral oil used in the Vascepa study, the benefit may not have been as obvious. This second study also looked at vitamin D, with participants taking 2000 units versus dummy pills for five years. Unfortunately the vitamin D showed no additional benefit effect on the odds of heart disease or stroke, but there was a very slight decrease in cancer deaths. Because cancer can take years to develop, the study authors advocated for a longer study to define this possible benefit. However other experts, such as Dr. Clifford Rosen formerly of Bangor and now working for Maine Medical Center advised that these Vitamin D effects be interpreted with caution.
So what's the bottom line for the average informed health care consumer? If you have the defined diagnosis of elevated triglycerides, you would be wise to have the conversation with your personal physician on how to address this. Certainly if you were able to treat this with the standard lower carbohydrate diet that is advised initially for most patients, that would not only be cheaper but probably safer in the long run. However if this preventive intervention were not effective for you, you may be a candidate for this class of medication. For the rest of us, you may want to save the dollars that you were spending on high dose vitamin D or fish oil and put it to better use - like that fishing vacation in the Gulf of Mexico. You would likely gets lots of vitamin D from the sunshine (don't forget your block!) but with luck you could enjoy some tasty fish dinners and have more than just the beneficial oils!