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Thanks to the pleasure of SCOTUS, we had a lot of heart failure moments last week, so let's talk about something good for your heart! I am a big skeptic of vitamins and supplements, but they earn billions of dollars a year from consumers who want to do healthy things for their bodies. At best, nothing proves that they improve anything except perhaps your peace of mind: taking fish oil tablets will counterbalance those Krispy Kremes you feel guilty of. Well, Nopety Nope. A 2013 study showed that taking n-3 fatty acid supplements (think fish oil) had no advantage over placebo. It was a large study with more than 12,000 subjects enrolled and published in the New England Journal of Medicine. Investigators compared death rates, heart attacks and strokes in both groups and found no difference. Nothing. Nada, amigos. There are many other studies that also show no benefit. But all this changed a week ago with Vascepa Phase III study of Amarin.
More details about this in a moment, but first a quick reminder of the types of lipids (fats) inside you and why the levels in your blood are important.
Wisdom tells us that there are three main types of lipids: triglycerides, steroids and phospholipids. There are other ways to classify them and other types (some antibiotics, for example), but that will be enough for us today and for the heart in good health. Let's hit each one in the reverse order.
phospholipids
"Phospo" for the atom of phosphorus present in every molecule and making it the freshest fat that is. Lipids, for, hum, the lipid part of the molecule. Why are these fat molecules the coolest? Glad you asked! The phosphor "head" of the molecule gives it a certain charge, distinct from the fat "tail". Because of this structure, in water, molecules self-organize into structures called liposomes. In your body, they are the ones that form the membranes of your cells. Without our microscopic, sperm-like little friends, you could not have cells and therefore not have life. Here is a diagram of the little guys and how they like to line up in the water and make your cell membranes:
steroids
You see steroid and think about this:
Ah, but that's only one aspect of the category. Hormones like testosterone are steroids, as are cholesterols. Cholesterol has a bad shot, but that 's because too much of that, mixed with other molecules, causes plaque build up in the arteries and you know why it' s bad. Still our little amigo is important for cell repair and the creation of new cells. So, we know that lowering high levels of cholesterol, or LDL specifically, is a good thing for you. It's where the statins came from and increased the lifespan of millions of people. But what about …
triglycerides
It's the one where a doctor says, "It looks like your LDL is going through the roof, your HDL is too weak to do a lot of good and your triglycerides MUST REALLY fall, Mr. President. These fats are important for energy storage. Sugars and starches are great for fast energy, but triglycerides are more effective molecules for storing energy that you might need if you're late. Tweet the wisdom you saw earlier in Fox News. You NEED triglycerides, but you do not want them too much because they will obstruct the heart's ducts and increase your risk of heart attacks, strokes and death. Plus, you will not be too good on the golf course with your white polo shirt.
This brings us back to fish oil, and more specifically to omega-3 fatty acids, which have some types of fish (salmon, etc.) that are full. Another important thing at the end of this paragraph is that there are two main types of fatty acids in fish oil, docosahexaenoic acid (DHA) and acid. eicosapentaenoic acid (EPA). As I said, all studies on fish oil supplements have been negative for any type of heart benefit. It changed last week! Vascepa is a drug already approved to reduce triglycerides in patients with very high levels. What they showed in the new study, however, is that the drug can actually reduce the rate of death, heart attack and stroke compared to a placebo. Why did this medicine work where other drugs and supplements based on fish oil extracts have failed? All those who have failed so far have been a mixture of fatty acids. Vascepa is made from EPA only. This is probably the differentiating factor, but we can not know for sure that the dose tested was also much higher than what other competing drugs and supplements have tried. However, you can not argue with the highly statistically significant 25% decrease in cardiovascular events observed in the study. Whatever the specific reason, it is a solid effect that most stock analysts have not anticipated. After the announcement, Amarin's shares soared above a presidential LDL level after three Big Macs of 2 am.
Here is a pdf of the design of the REDUCE-IT study and a link to the high-level results. Details will be presented on November 10th at the American Heart Association meeting in Chicago. Stay tuned for now … and go eat salmon, bitches!
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