Thursday, September 13, 2012

Omega 3 Fatty acids in the news, The rest of the story.


  • Omega 3 fatty acids had their moment in the news yesterday .

  •  The headline , omega 3's have no effect in reducing the risk of cardiovascular disease. 

  • I believe they were referring to the ORIGIN study. This was a large study, 12,537 people with high risk for cardio vascular disease who had impaired fasting glucose , impaired glucose tolerance ,or recent onset of type 2 diabetes. 
  •  The ORIGIN Trial Investigators. N-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med. 2012; Jun 11. Epub ahead of print.

  • End points
  •  Primary end points cardiovascular death , secondary end points 
  • Secondary end points , nonfatal heart attack or stroke ,all cause mortality or arrhythmic death

  • The purpose was to answer 2 questions

  •  #1 Question -
  •       To investigate wether insulin replacement with Glargine ( Lantus insulin ) and
  •       maintaining a fasting glucose below 95mg/dl (5.3 mm/l) would reduce the risk 
  •       of cardiovascular disease.

  •      Answer - 
  •                       No , there was no significant reduction in cardiovascular outcome in
  •                       the insulin group
  •                   
  •     The rest of the story   
  •                       There was no increase in the risk of developing cancer.
  •                       There was a decrease in the progression to type 2 diabetes with
  •                       maintaining a normal fasting glucose.
  •                   

  •   # 2 Question
  •        To evaluate cardiovascular risk in patients taking  1 capsule  containing 
  •         900 mg o omega 3 fatty acid
  •       
  •             
  •        Answer - there was no reduction in cardiovascular risk  over the 6.2 years of 
  •                         the study.

  •       The rest of the story and comment
  •                      baseline Triglycerides 152 mg/dl 
  •                                       LDL cholesterol 112 mg/dl
  •                     The treatment group  had a 23.5 mg/dl decrease in triglycerides 
  •                     compared to a 9% decrease in the placebo group. 
  •                     and  no significant  decrease in LDL  or increase in HDL. They did 
  •                     demonstrate that a small dose has a small effect on lipids.
  •                  .
                   Comment. 
                        The good news in the rest of this story is that early aggressive correction
                        of glucose can slow the progression of type 2 diabetes . 
                        
                        The finding of no increase in the risk of cancer in patients using glargine 
                         (Lantus )relieves some of the early concerns about glargine and cancer.
                        
                            Omega 3 fatty acids are effective for reducing abnormally elevated
                            triglyceride. The average baseline  triglyceride level in the study was 152 
                            mg/dl( normal < 150 mg/dl ) .
                           
                            This was a research study, in patients with no clinical indication for using
                            omega 3 fatty acids , and they successfully demonstrated that there was 
                            no benefit in  taking low dose ( < 1 gram ) of omega -3 - fatty acid.
                           
                           The therapeutic dose for elevated triglycerides is 4 to 6 grams of fatty 
                            acids EPA and DHA. Most of the patients would not have received
                            omega -3 -Fatty acid in their doctors office and would have instead
                            received a recommendation to adjust their statins  to correct their LDL 
                            cholesterol to < 70 mg/dl.
                          
                 I have attached some of my previous blogs for your review on this topic.

    Have fun , Be Smart and read the details
    David calder,MD

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    Your comments and questions are appreciated. David Calder,MD