The American Heart Association released study information and new guidelines at their annual conference in November 2018. I was surprised at some of the changes and wanted to share the information with Deaconess patients and the community.
Fish oil and vitamin D don’t reduce cancer or cardiovascular events as expected
Daily fish oil, also referred to as omega-3 fatty acids, and vitamin D are taken by millions of people for the purpose of reducing the risk for heart disease and invasive cancers. A clinical trial funded by the National Institutes of Health investigated whether taking daily dietary supplements of vitamin D3 (2000 IU) or omega-3 fatty acids (Omacor® fish oil, 1 gram) reduces the risk for developing cancer, heart disease and/or stroke in people who do not have a prior history of these illnesses. The study, called VITAL, monitored 26,000 healthy, low-risk patients for approximately five years and demonstrated the following results:
Vitamin D supplementation
• Did not reduce risk of cancer
• Did not reduce risk of major cardiovascular events (heart attack, stroke, or cardiovascular death considered together)
• Appeared to reduce risk of cancer-related death
Omega-3 fatty acid supplementation
• Did not reduce risk of cancer
• Did not reduce risk of major cardiovascular events in the overall study population, but did reduce risk of these events by 19% in people with low fish intake
• Reduced risk of heart attack by 28%, when heart attack was considered separately from other cardiovascular events; the benefit appeared strongest in African Americans
A different clinical trial called REDUCE-IT (Reduction of Cardiovascular Events with EPA - Intervention Trial) wanted to evaluate whether icosapent ethyl + statin is superior to statin therapy alone in preventing/reducing long-term cardiovascular events in patients with very high triglycerides.
Results of the trial show a significant reduction of cardiovascular events, like heart attack and stroke, for patients taking the fish-derived compound, icosapent ethyl. (This compound comes from the omega-3 fatty acid eicosapentaenoic and is in a medicine called vascepa that we currently prescribe to patients with high triglycerides.)
Baby aspirin didn’t protect against heart attacks or strokes as expected
A clinical trial called Aspirin to Reduce Risk of Initial Vascular Events (ARRIVE) evaluated the success of a daily 100 mg aspirin in preventing a first cardiovascular event like heart attack or stroke for patients with a moderate 10-year risk for heart disease. (The benefits of taking aspirin to prevent a second or subsequent cardiovascular event are well established.)
Unfortunately, the study found that taking a daily aspirin was not beneficial and did not reduce or prevent cardiovascular events. These results mean doctors should decide on a case-by-case basis if a patient should take a daily aspirin. The results also mean patients should not decide on their own to start taking a daily aspirin.
Using medication to treat high cholesterol – the guidelines changed
Cholesterol guidelines related to who should take medicine and when and how much continues to be confusing for patients and physicians. During the annual conference, the American College of Cardiology and the American Heart Association gave us specific guidelines to help clear up the confusion.
Top Take-Home Messages to Reduce Risk of Cardiovascular Disease Through Cholesterol Management
(from the following study: 2018 Guidelines on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines)
- In all individuals, emphasize a heart-healthy lifestyle. A healthy lifestyle reduces the risk of cardiovascular disease at all ages.
- In patients with cardiovascular disease, reduce LDL cholesterol with statin therapy (medication)
- Personalize the treatment plan for each patient using these guidelines:
- Have a clinician–patient risk discussion, i.e. what are your specific risk factors, before starting statin therapy.
- Calculate the 10-year risk of heart disease or stroke.
- If the risk is greater than 7.5%, treatment with statin medication is indicated.
- If the risk is around 7.5% or if a decision about statin therapy is uncertain, consider measuring Coronary Artery Calcium (CAC). If CAC is zero, treatment with statin therapy may be withheld or delayed.
Doctors determine a Coronary Artery Calcium (CAC) score from the results of a non-contrast chest CT scan. This test captures images of the heart using radiation comparable to that of a mammogram. Deaconess offers Heart Scan, which is CAC testing without a doctor's referral. Anyone (35 and older) can request the screening and it costs $49.
If you don’t work in the medical field, keeping up with the latest science and recommendations is difficult. I hope this information helps you have meaningful conversations with your doctor about heart health.