Vitamin D3 and Omega-3 Study

There’s a new study funded by the National Institutes of Health that seeks to understand whether supplementing on a regular basis with Vitamin D3 (about 2000IU/day) and fish oil (about 1 gram of omega-3 fatty acids/day) can decrease rates of heart disease, stroke or cancer in people who do not have a history of these diseases. It’s called the VITamin D and OmegA-3 TriaL (VITAL) research study, and will attempt to enroll 20,000 men and women in the US and follow their medical histories for a number of years. Note that the study will enroll only men over 60 and women over 65–ages at which heart disease, stroke and cancer begin to occur with greater frequency.

Here’s the website of the study, which is being run by Harvard Medical School and the Brigham and Women’s Hospital in Boston, MA:

http://www.vitalstudy.org/

The designers of this research were interested in looking at both Vitamin D3 and fish oil/omega-3 fatty acids because of the accumulating evidence for the health benefits of these two widely investigated supplements, and because the two show different mechanisms of action in inhibiting inflammatory responses in the body. The study is designed to separate out the effect of each of the two supplements, but also investigate whether combining the two produces the added benefit in terms of disease prevention.

Note that there is already a great deal of evidence to support the health benefit of omega-3 fatty acids for people with heart disease. And there is likewise evidence to support the benefit of Vitamin D3 (plus calcium) for those with deficiency-related conditions like bone loss. The VITAL study, on the other hand, has the specific goal of looking at whether regular supplementation can actually prevent development of cardiovascular disease and/or cancer in healthy people.

NYBC stocks Vitamin D3 1000IU and ProOmega (1000mg/60 softgels).
Purchasing these two at the member’s cost of about $26 will give you a two months supply at the VITAL study’s dosages.

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B vitamins for eye health

A heart disease study sponsored by the NIH has also yielded some interesting information about the relationship between B vitamins and eye health. The research study, from Brigham and Women’s Hospital in Boston, found that taking a mixture of B vitamins, including B-6, folic acid and B-12, lowered the chance of middle-aged women developing macular degeneration (a common form of vision loss in older adults) by one-third. The study, which tracked more than 5000 women age 40 and older, was published in the Archives of Internal Medicine, Feb. 23, 2009.

Note that NYBC stocks this B vitamin supplement:

B-right (Jarrow)

B-right includes folic acid, B-6 and B-12; one of the rationales for its formulation is to prevent buildup of the chemical homocysteine, which in studies has been associated with heart attacks.

Do Abacavir and ddI (Didanosine) Contribute to Risk of Heart Attack?

This was the topic of a presentation at the 15th Conference on Retroviruses and Opportunistic Infections (CROI) in Boston in February 2008. Researchers from a large European database that collects information on over 200 HIV clinics unexpectedly found that recent use of abacavir (in the past six months), and to a lesser extent ddI, was linked to an increased risk of heart attacks.

Although the overall level of heart attack was low (1.6%) in the group of more than 33,000 HIV+ individuals studied, it was nonetheless double the rate that would otherwise be expected.

These findings, which continue to be investigated, are focusing for now on the particular risk that taking abacavir (or ddI) might present for those who already have some risk factor for cardiovascular disease, such as being diabetic, being a smoker, having high blood pressure, or having higher than normal lipids (cholesterol and triglycerides). Also under discussion is whether screening for hypersensitivity to abacavir (shown by about 8% of people), which is a simple blood test, could steer those most susceptible to this increased heart attack risk away from abacavir.

It’s also clear that many HIV positive people taking abacavir could take steps to minimize their risk for cardiovascular disease by:

1. quitting smoking
2. lowering high lipid levels
3. lowering high blood pressure
4. getting treatment for diabetes
5. changing diet
6. starting an exercise program

(See entries on this blog for some suggestions regarding #s 2, 3, and 4.)

We’ve presented the above information based especially on the Canadian AIDS Treatment Information Exchange treatment update on this topic, which includes a bibliography for further reading. The complete CATIE update can be read at:

http://www.catie.ca/catienews.nsf/00a48c8905294f0b8525717f00661eb8/5a61325343866b8b8525741d005d20ce!OpenDocument

Fish oil (omega-3 fatty acids) used after heart attacks in Europe–why not in the US?

Here’s an excerpt from a 2006 New York Times article, which points out some of the resistance to supplements that is a feature of US medicine–in this case, rather clearly to the detriment of American cardiac patients.

Note: the American Heart Association’s recently updated guidelines on fish oil / omega-3’s are posted on this blog under “Omega-3” – Oct. 23, 2007.

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In Europe It’s Fish Oil After Heart Attacks, but Not in U.S.

by ELISABETH ROSENTHAL

ROME — Every patient in the cardiac care unit at the San Filippo Neri Hospital who survives a heart attack goes home with a prescription for purified fish oil, or omega-3 fatty acids.

“It is clearly recommended in international guidelines,” said Dr. Massimo Santini, the hospital’s chief of cardiology, who added that it would be considered tantamount to malpractice in Italy to omit the drug.

In a large number of studies, prescription fish oil has been shown to improve survival after heart attacks and to reduce fatal heart rhythms. The American College of Cardiology recently strengthened its position on the medical benefit of fish oil, although some critics say that studies have not defined the magnitude of the effect.

But in the United States, heart attack victims are not generally given omega-3 fatty acids, even as they are routinely offered more expensive and invasive treatments, like pills to lower cholesterol or implantable defibrillators. […]

“Most cardiologists here are not giving omega-3’s even though the data supports it — there’s a real disconnect,” said Dr. Terry Jacobson, a preventive cardiologist at Emory University in Atlanta. “They have been very slow to incorporate the therapy.”

[…]

Note: Full article appeared in NYT Oct. 3, 2006 and was accessed from the online edition by us on Nov. 11, 2007.

Fish and Omega-3 Fatty Acids: American Heart Association Recommendation

This recommendation appears on the website of the American Heart Association:  
Omega-3 fatty acids benefit the heart of healthy people, and those at high risk of — or who have — cardiovascular disease. We recommend eating fish (particularly fatty fish) at least two times a week.  Fish is a good source of protein and doesn’t have the high saturated fat that fatty meat products do.  Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in two kinds of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).To learn about omega-3 levels for different types of fish — as well as mercury levels, which can be a concern — see our Encyclopedia entry on Fish, Levels of Mercury and Omega-3 Fatty Acids.We also recommend eating tofu and other forms of soybeans, canola, walnut and flaxseed, and their oils. These contain alpha-linolenic acid (LNA),  which can become omega-3 fatty acid in the body. The extent of this modification is modest and controversial, however. More studies are needed to show a cause-and-effect relationship between alpha-linolenic acid and heart disease.The table below is a good guide to use for consuming omega-3 fatty acids.Summary of Recommendations for Omega-3 Fatty Acid Intake

Population Recommendation
Patients without documented coronary heart disease (CHD) Eat a variety of (preferably fatty) fish at least twice a week. Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts).
Patients with documented CHD Consume about 1 g of EPA+DHA per day, preferably from fatty fish.  EPA+DHA in capsule form could be considered in consultation with the physician. 
Patients who need to lower triglycerides  2 to 4 grams of EPA+DHA per day provided as capsules under a physician’s care. 

 Patients taking more than 3 grams of omega-3 fatty acids from capsules should do so only under a physician’s care.  High intakes could cause excessive bleeding in some people.

Background

In 1996 the American Heart Association released its Science Advisory, “Fish Consumption, Fish Oil, Lipids and Coronary Heart Disease.” Since then important new findings have been reported about the benefits of omega-3 fatty acids on cardiovascular disease.  These include evidence from randomized, controlled clinical trials.  New information has emerged about how omega-3 fatty acids affect heart function (including antiarrhythmic effects), hemodynamics (cardiac mechanics) and arterial endothelial function.  These findings are outlined in our November 2002 Scientific Statement, “Fish Consumption, Fish Oil, Omega-3 Fatty Acids and Cardiovascular Disease.”

The ways that omega-3 fatty acids reduce CVD risk are still being studied.  However, research has shown that they

  • decrease risk of arrhythmias, which can lead to sudden cardiac death
  • decrease triglyceride levels
  • decrease growth rate of atherosclerotic plaque
  • lower blood pressure (slightly)

What do epidemiological and observational studies show?

Epidemiologic and clinical trials have shown that omega-3 fatty acids reduce CVD incidence.  Large-scale epidemiologic studies suggest that people at risk for coronary heart disease benefit from consuming omega-3 fatty acids from plants and marine sources.

The ideal amount to take isn’t clear.  Evidence from prospective secondary prevention studies suggests that taking EPA+DHA ranging from 0.5 to 1.8 grams per day (either as fatty fish or supplements) significantly reduces deaths from heart disease and all causes.  For alpha-linolenic acid, a total intake of 1.5–3 grams per day seems beneficial.

Randomized clinical trials have shown that omega-3 fatty acid supplements can reduce cardiovascular events (death, non-fatal heart attacks, non-fatal strokes).  They can also slow the progression of atherosclerosis in coronary patients.  However, more studies are needed to confirm and further define the health benefits of omega-3 fatty acid supplements for preventing a first or subsequent cardiovascular event.  For example, placebo-controlled, double-blind, randomized clinical trials are needed to document the safety and efficacy of omega-3 fatty acid supplements in high-risk patients (those with type 2 diabetes, dyslipidemia, hypertension and smokers) and coronary patients on drug therapy.  Mechanistic studies on their apparent effects on sudden death also are needed.

Increasing omega-3 fatty acid intake through foods is preferable.  However, coronary artery disease patients may not be able to get enough omega-3 by diet alone.  These people may want to talk to their doctor about taking a supplement.  Supplements also could help people with high triglycerides, who need even larger doses.  The availability of high-quality omega-3 fatty acid supplements, free of contaminants, is an important prerequisite to their use.

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For NYBC’s fish oil supplement, see the product description for Jarrow’s Max DHA.

And we add some general dietary advice about fat:

Remember that the balance of fats you eat is the first, most important step to consider. Dump the hydrogenated fats (found in cookies, margarine and lots of things; read labels!), limit saturated fat intake (dairy, red meat, fried stuff) and increase good fat intake (deep sea fish like salmon, tuna; olive oil, hemp oil, etc.) Lastly: in controlling cholesterol through modifications in diet, it’s not always emphasized enough that sugar intake will also influence your cholesterol levels!

Niacin and statin combination therapy to protect against risk of heart attack or stroke

The National Institutes of Health is funding a large-scale study in the US and Canada to follow thousands of heart patients who take niacin plus a statin drug, versus those taking only a statin drug. A widely-held expectation is that the study will add further support to the already substantial case for niacin + statin as the therapy of choice to protect against heart attack or stroke for those with cardiovascular disease.

While statins have shown effectiveness in reducing LDL, the so-called “bad cholesterol,” it is niacin that takes the prize in increasing levels of HDL, also known as the “good cholesterol.” In past studies, niacin was found to increase HDL by as much as 35%, while also reducing artery-clogging triglycerides as much as 50%. Moreover, niacin was the subject of landmark long-term research begun in the 1970s, which showed it substantially reduced second heart attacks and strokes in men who had suffered a first heart attack.  

A recent analysis of 23 clinical trials conducted by researchers at the University of Washington concluded that increasing HDL by 30% and decreasing LDL by 40% would reduce the risk of heart attack or stroke by 70% in a typical cardiovascular patient. Thus, combining the HDL-raising capacity of niacin with the LDL-lowering capacity of statin drugs may offer one of the most promising avenues toward improving cardiovascular care and increasing survival rates.

Notes and warnings:

–Statin drugs have side effects, so their use is not without risk (see the post on this blog, “When FDA-approved drugs stumble…”

–An earlier study led by Dr. B Greg Brown of the University of Washington reported that antioxidant vitamins such as vitamin E, vitamin C, and b carotene curb the rise in HDL levels seen with the niacin + statin combination. Accordingly, patients using this combination therapy may be advised to avoid antioxidant supplementation. (New England Journal of Medicine 2001;345:1583-92).

–For futher details on suggested use, see NYBC’s description of Niacin 100mg and Niacin 400mg. These are timed-release formulas; also provided are guides for minimizing the “flushing” that can accompany niacin use. Note that, as always, NYBC recommends consulting a health care professional about use of this dietary supplement.

–Background on niacin and the renewed interest in it as part of a combination therapy for cardiovascular patients: Michael Mason, “An Old Cholesterol Remedy is New Again,” in The New York Times, Jan. 23, 2007.