Omega-3s no benefit on top of modern heart drugs

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NEW YORK: Omega-3 fatty acids may offer no added benefit for heart attack survivors who are already taking the best available drugs, suggests a new study out of Germany.

The findings counter a large Italian study conducted in the mid-1990s that highlighted a protective effect of omega-3s for patients after a heart attack, an event more than 1.25 million Americans experience each year.

Over the last 10 years, however, prevention and treatment of heart attacks has dramatically improved, lead researcher Dr. Bernhard Rauch of the University of Heidelberg, in Germany, said in an e-mail to a British news agency.

In an effort to see whether omega-3s might still confer a benefit on top of updated therapies, Rauch and his colleagues looked at nearly 4,000 Germans, averaging 64 years old, who had suffered a heart attack within the previous 3 to 14 days.

The study was commissioned by Trommsdorff Arzneimittel, a German maker of vitamins and packaging, and partly funded by Pronova Biopharma, the Norwegian producer of a prescription-strength omega-3 supplement sold in Europe and the U.S. The researchers randomly assigned each patient to take either a capsule containing a gram of DHA and EPA omega-3 fatty acids, or a similar looking capsule filled with olive oil, every day for a year. The omega-3 dose was approximately equivalent to a small 60- to 70-gram serving of salmon.

Three quarters of the participants were men, and most in the omega-3 group were also taking standard preventive medications such as aspirin (95 percent), beta-blockers (94 percent), anti-clotting agents (88 percent) and statins (94 percent). Similar medication regimens were followed in the control group taking olive oil. Over the course of the study, only 1.5 percent of patients in both groups succumbed to sudden cardiac death, a situation in which the heart abruptly stops beating.

Further, there were no significant differences in mortality or cardiovascular events between patients taking omega-3s or olive oil, report the researchers in the journal Circulation.

"Therapy is very much improved in the last 20 years and this is very good news for patients," Dr. Roberto Marchioli of Consorzio Mario Negri Sud, in Italy, said.

Marchioli, who was the lead researcher of the earlier Italian study, suggested that the relatively small sample size and short duration of the new study, on top of this lowered event rate, may have limited its ability to detect a true benefit of the omega-3s. His study was conducted on a much larger population of patients, over a longer period of time.

Both studies used the same dosage of omega-3s. It is possible that larger quantities may provide greater benefit, although Marchioli noted that the most effective dose has not yet been established.

Dr. Robert H. Eckel of the University of Colorado, Denver, and author of an accompanying editorial in Circulation, agreed that the study might not have been powerful enough to draw a clear conclusion.

He suggests a future, larger study to test the safety and effectiveness of higher doses of omega-3s. "High-dose omega-3s are used to lower triglycerides (fat in the blood) now," Eckel said.

For the time being, Eckel suggests heart attack survivors stick with a heart-healthy diet and proven medications. "I would not expect small doses of extra omega-3 fatty acids to do any harm," said Rauch. "But I do not think that omega-3 tablets are able to replace the mixture of heart-healthy food including fruits, vegetables, salads, grain and fish as represented in Mediterranean food."

Rauch added that the cost of the supplements should also be considered. In the U.S., a monthly supply of one-gram capsules can run well over $15, more than the cost of some statins, which are recommended to reduce cholesterol levels.

Maintaining this healthy diet, not smoking and getting adequate exercise, he said, should eliminate any need for additional omega-3 supplementation after a heart attack.