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Take fish oil or vitamin D? Large studies provide long-awaited answers about who benefits and does not benefit from these popular nutrients.
Fish oil consumed by healthy people, at a dose that is found in many supplements, has not clearly demonstrated its ability to reduce heart risks or cancer. Same thing for vitamin D.
But higher amounts of purified prescription fish oil have reduced heart problems and heart mortality in people with high triglyceride levels, a type of fat in the blood and other risks of disease heart. The doctors applauded the results and said that they could suggest a new treatment option for hundreds of thousands of patients like these.
Up to 10% of American adults consume fish oil. Even more, take vitamin D, despite no major studies to support the many health claims that have been made.
"Those who peddle it promise it's good for everything," but in this definitive test, vitamin D "has revealed no great effect," said Dr. James Stein, a cardiologist at the University of California. Wisconsin-Madison. He played no role in the studies and has no connection with the companies concerned.
The findings were revealed Saturday at a conference of the American Heart Association in Chicago and published by the New England Journal of Medicine.
About fish oil
These oils, also known as omega-3 fatty acids, are found in salmon, tuna and some other fish. They reduce triglycerides and inflammation and can have other effects. There are different types, including EPA and DHA.
One study tested 4 grams per day of prescription vascepa from Amarin Corp., which is an EPA concentrate, in more than 8,000 patients with elevated triglyceride levels and increased risk of heart problems for a variety of reasons. Everyone was already taking a statin such as Lipitor or Zocor to lower cholesterol. Half received vascepa and the rest, mineral oil capsules for comparison.
After five years, about 17% of Vascepa patients had one of these problems: heart attack, stroke, cardiac death or clogged arteries requiring medical care, compared with 22% of others.
This resulted in a 25% reduction in risk. Individually, heart attacks, heart-related deaths and strokes were all less common with vascepa. Only 21 people should take Vascepa for five years to prevent one of the main problems studied: a favorable probability, said Stein.
Adverse effects may be of concern: More people taking Vascepa were hospitalized for an irregular heart rate of 3% compared to 2% in the comparison group. Doctors say it's curious, because other research suggests that fish oil reduces this risk.
The concern about the heart rate problem is that it can increase the risk of stroke, but there has been less stroke in Vascepa patients, said Dr. Deepak Bhatt, director of Boston Brigham and Women's Hospital study.
Vascepa costs about $ 280 a month; many insurers cover it. Amarin sponsored the study and some study leaders work or consult for the company.
A broader test
The other study tested a daily dose less than 1 gram of a different type of fish oil _ an EPA / DHA combo sold under the name of Lovaza or Omacor and in form generic _ in 26,000 people without any heart problems or cancer.
After about five years, the combined measure rates of heart attacks, strokes and other problems were similar for fish oil users and for a control group. Cancer rates and deaths were also similar.
There were fewer heart attacks in the fish oil group – 145 versus 200 in the comparison group. Dr. JoAnn Manson of Brigham and Women's, who was responsible for the study, called the call "substantial benefit," but several independent experts disagreed because of the way the study was designed to track this result. and some other results.
"These results are hypothetical and should be confirmed by a separate trial," said Dr. Steven Nissen of the Cleveland Clinic.
COMPARISONS OF FISH?
Both studies share a problem: the oils used for comparison groups, which may not have been true placebos. The study on Vascepa used mineral oil, which interferes with statin-based drugs, increases cholesterol levels and could have worsened the results of the comparison group and give Vascepa a more beautiful appearance. that she was really it.
The other study used olive oil, which could have helped the comparison group to do better, possibly masking any benefit to others from fish oil.
Leaders of both studies said that the effects of comparator oils were not enough to change key findings, independent experts confirmed. But Nissen, who runs another study on fish oil, uses corn oil for comparison.
THE VITAMIN `SUNSHINE '
The Manson study also tested vitamin D, produced by sun exposure. It is difficult to get enough food such as milk, eggs and oily fish, although many foods are now fortified. Some studies have shown that people with lower D levels are more likely to develop cancer, but it is not known if supplements alter this risk.
Study participants took 2,000 international units of D-3 (the most active form of vitamin D, also known as cholecalciferol) or fake vitamin pills for five years.
Vitamin D does not affect the risk of heart attack, stroke or cancer. After excluding the first two years of use, the researchers found a decrease in the number of cancer deaths among patients in the vitamin 112 group versus 149 in the placebo group.
"Cancer can take years to develop," Manson said. "It looks promising," and people will be studied longer to see if the trend continues, she said.
Several other experts said that these figures only suggested a potential benefit that should be deepened.
"These" positive "results should be interpreted with caution," said Dr. Clifford Rosen of the Maine Medical Center Research Institute and John Keaney Jr. of the University of Massachusetts in a commentary published in the medical journal.
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