Monday, August 30, 2010


The European Society of Cardiology congress is currently in session in Stockholm. I have a glance at the program. Nothing earth shuttering is coming out. Data and clinical trials will be announced, but nothing that ( in my opinion, ??bias ) will change the practice of cardiology.
When I open my Star newspaper this morning, I saw that the Star medical editor had picked out a report from the ESC meeting, saying that Omega 3 fatty acid fish oils, did not help the heart. This generalisation is not accurate, nor correct. I suppose, it does sell newspaper. The facts .........
In the ESC ( still on-going ), the Dutch workers, led by Dr Daan Kromhout of the Wageningen U, reported on the Alpha Omega Trial. This was a study of 4,837 patients aged 60-80 years. These patients had all suffered a heart attack and were on follow-up. They were followed up for 40 months. These 4,837 patients were divided into 4 arms. One arm was given omega 3 FA + omega 6 FA, the second arm plant alpha linolenic acid. The third arm, all three FA, and the fourth arm placebo. After 40 months of follow up, the investigators found no difference in the 4 groups in terms of any cardiovascular events, including death, re-MI, the need for revascularisation. Thus the headlines in Star.
Of course the Star was comparing this result with previous established studies which showed that Omega 3 FA reduces serum triglycerides and serum fibrinogen, and also reduces sudden cardiac death. These are the reasons we use omega 3 FA.
These established findings were based on work done by the Italian and Japanese workers in the 90s and early 2000.
How then to explain the difference?
Well, this present study in much smaller then the previous two, especially as these group of Dutch workers chose to divide an already small cohort, into 4 arms, thereby making it more difficult to get to a significant number, by virtue of their small numbers per group. It was also important to note that this Dutch study had an older population. Both the earlier Italian and Japanese study had a younger population. The dose of omega 3 FA was way too small and they chose to add omega 6 FA and also plant alpha linolenic acid. How much effect these other FA had negatively, needs further study. I think the present Dutch workers were surprised that the number of deaths in their study, were way lower then the number of deaths expected, telling us that the background medical medical and lifestyle changes had positively impacted on the number of expected deaths from heart attacks between the 90s and presently. Heart attack patients were doing better now and so it was harder to find a difference.
Be that as it may, fish oil, or omega 3 FA acid, or more precisely " eicosapentaenoic acid " is good for the heart and good for post heart attack victims. Medical management of the post heart attack patients is much better now when compared to the 90s.
So Star. the details are important.

No comments: