COMMENTARY

Fish Oils to Prevent Heart Disease

It Really Didn't Matter

At the end of the day they had adequate power; they had actually gone a little bit past their planned recruitment -- over 11,000 participants -- because there was an issue of wanting to get every physician to recruit patients.

Basically, this 1 figure tells the whole story. I am going to try to sharpen the view of the graph. It's the primary event curve, and it looks like there's only 1 line. But there are 2 lines: placebo (which has a little bit of olive oil in it) vs the fish oil. There's no difference. No difference on any endpoint: death, stroke, MI, hospitalization, you name it.

It is interesting that there was a statistically significant better tolerance of the fish oil than there was of the placebo. It was slight (0.03), but it's an interesting footnote.

What Does This Say About Fish Oil?

I don't know about you, but I have an awful lot of patients who come to me on fish oil and I try to implore them to stop taking it. This trial arms us [with proof against fish oils] for our patients who have not had an MI, who have not had heart failure, where the worry is not suppression of ventricular arrhythmia (and even that is a little suspect). Fish oil does nothing and we cannot continue to argue about either "the right dose" or "the right preparation." It's a "nada effect."

I think this is a really important trial in cardiovascular medicine. It's also interesting that 70% of the patients [in the trial] had hypercholesterolemia and only 40% were taking statins. This group [of patients] was even more "loaded," if you will, to derive some benefit.

Fish oil is a "no-go." If it doesn't work in this group, it's hard to imagine in lesser-risk groups that it's going to have any salutary impact.

I really appreciate you tuning in to Topolog. I'll be interested in your thoughts on fish oils. It's been a fishy story for a long time.

Thank you.

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