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International Updates

Heart

Issue 78

KING and colleagues, Australian College of Maharishi Vedic Medicine, New South Wales, reviewed (50 references) research on the use of transcendental meditation (TM) for the treatment and prevention of heart disease.
Background:It is now widely accepted that stress plays an important role in the development and symptoms of coronary heart disease (CHD). Increasingly, stress reduction techniques – the most widely tested and used being TM – are being used to help prevent and treat CHD.
Discussion:The evidence indicates that TM can reduce high blood pressure and the incidence of atherosclerosis, improve symptoms in patients with heart disease, lower rates of hospitalization, lower cholesterol levels and also help reduce smoking. Not all meditation and stress reduction techniques may have these effects. Further studies are needed to uncover the physiological mechanisms underlying the beneficial cardiovascular effects of TM and other meditation and stress reduction techniques. More in-depth study is also needed to confirm preliminary results indicating beneficial effects of TM on atherosclerosis, heart disease and high blood pressure.
King MS et al. Transcendental meditation, hypertension and heart disease. Australian Family Physician 31 (2): 164-8. Feb 2002.

DAY, Faculty of Nursing, Universal College of Learning, Manawatu Polytechnic, Palmerston North, New Zealand, reviewed (31 references) research indicating that relaxation can help relieve pain and distress in patients suffering angina.
Background: Patients suffering angina due to heart disease endure the trauma and stress of what they perceive to be a life-threatening situation in addition to the pain involved, although standard nursing care is mainly aimed only at relief of pain. The distress of chest pain may exacerbate the pain itself, so that analgesic medication alone is not enough to comfort patients.
Discussion: There is evidence to indicate that relaxation can be very helpful in both treating the symptoms of angina and preventing its occurrence (Altice & Jamison, 1989; Guzzetta, 1989; Tiernan, 1994). The author of this article emphasizes the need for nurses to re-examine the ways in which they deal with patients suffering chest pain, in order to address individual needs – many patients may be just as distressed by the implications of their illness and symptoms as they are by the pain it causes, so that anxiety and distress make the experience even worse. The article discusses how relaxation techniques, used in conjunction with analgesic medication, may be useful adjuncts to standard nursing care to help patients with cardiac chest pain achieve effective relief from suffering.
Day W. Relaxation: a nursing therapy to help relieve cardiac chest pain. The Australian Journal of Advanced Nursing 18 (1): 40-4. Sep-Nov 2000.

ALBERT and colleagues, Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02215-1204, USA, calbert@partners.org, investigated whether low blood levels of long-chain n-3 polyunsaturated fatty acids (PUFAs) were associated with sudden death as the first manifestation of cardiovascular disease.
Background: Existing evidence indicates that long-chain n-3 PUFAs found in fish have anti-arrhythmia properties and that dietary supplementation may be beneficial for patients who have survived a heart attack. Unfortunately, sudden death can be can be the first and only manifestation of cardiovascular disease. The researchers therefore investigated whether levels of long-chain n-3 PUFAs were related to the occurrence of sudden death in men with no prior history of cardiovascular disease.
Methods:This was a prospective case-control study that followed up a group of apparently healthy men for up to 17 years as part of the Physicians’ Health Study. The researchers analysed the fatty acid composition of blood samples previously collected from 94 men who died of ‘sudden death’ as the first manifestation of heart disease and from 184 men who were of similar age and smoking status to the 94 sudden-death cases.
Results: Low baseline blood levels of long-chain n-3 PUFAs were found to be associated with an increased risk of sudden death both before and after adjustment of data for possible confounding factors. Men whose blood levels were in the third and fourth highest quartiles were at significantly lower relative risks (RRs) of sudden death (adjusted RR 0.28, and adjusted RR 0.19, respectively) compared with men whose blood levels were in the lowest quartiles.
Conclusion: Higher blood levels of long-chain n-3 PUFAs, such as those found in fish, are strongly associated with a lower risk of sudden death as a first manifestation of cardiovascular disease in men.
Albert CM et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. New England Journal of Medicine 346 (15): 1113-8. Apr 2002.
Comment: Omega-3 fatty acids can literally be life-saving, as demonstrated by this research study conducted at a prestigious American Institute.

Issue 76

GALE and colleagues, MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK, crg@mrc.soton.ac.uk, investigated a possible relationship between antioxidant vitamin status and atherosclerosis of the carotid artery in the elderly.
Background: Initiation of the atherosclerotic process is believed to crucially involve oxidative metabolism of low-density lipoprotein (LDL). Antioxidant vitamins can help prevent oxidation of LDL. High consumption or high blood levels of such vitamins has been associated with a reduction in the risk of cardiovascular disease. Few studies have looked at the effects of antioxidant vitamins in the early atherogenic process.
Methods: Study subjects were 468 men or women aged 66 to 75 years living in Sheffield, UK. Intima media thickness and degree of stenosis in the extracranial carotid arteries were measured using duplex ultrasonography. Fasting plasma levels of vitamins C and E and beta-carotene were measured. Data were adjusted for age and cardiovascular disease risk factors.
Results: In men, a 20% higher plasma vitamin C level was associated with a 0.004 mm smaller intima media thickness, and a 20% higher beta-carotene level was associated with a 0.005 mm smaller intima media thickness. Men with low plasma levels of beta-carotene and cholesterol-adjusted vitamin E were 2.5 times as likely to have carotid stenosis of >30%, compared with men with high plasma levels of these vitamins. Among the women, there were no significant associations between plasma levels of antioxidant vitamins and either intima media thickness or carotid stenosis.
Conclusion: In men, high antioxidant vitamin status may reduce the risk of early atherosclerotic lesions.
Gale CR et al. Antioxidant vitamin status and carotid atherosclerosis in the elderly. The American Journal of Clinical Nutrition 74 (3): 402-8. Sep 2001.

Issue 74

DEWAILLY and colleagues, Public Health Research Unit, CHUL Research Centre, Centre Hospitalier Universitaire de Quebec, Ste-Foy, Canada, eric.dewailly@crchul.ulaval.ca, carried out a study to confirm the previously reported relationship between n-3 fatty acids and cardiovascular risk factors in the Inuit people of Nunavik, Canada.
Background: The traditional Inuit diet contains large amounts of marine food rich in n-3 fatty acids, which are believed to reduce the risk of cardiovascular disease.
Methods: 426 Inuit aged 18-74 years took part in a health survey in 1992, with data being obtained through home interviews and clinic visits. Blood samples were taken for analysis of the compositions of the plasma phospholipid fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
Results: Geometric mean concentrations of EPA, DHA and their combination in plasma phospholipids were: 1.99%, 4.52% and 6.83% (percentage of total fatty acids) respectively. There were positive relationships between n-3 fatty acids and HDL-cholesterol, LDL-cholesterol, total cholesterol and plasma glucose concentrations. Conversely, there were negative (inverse) associations between n-3 fatty acids and triacylglycerol concentrations and the ratio of total to HDL-cholesterol. There were no associations between n-3 fatty acids and diastolic or systolic blood pressure or plasma insulin.
Conclusion: It would appear that a diet high in marine products, containing EPA and DHA, reduces some risk factors for cardiovascular disease. The low mortality rate from coronary heart disease reported in Inuit is probably a consequence of their traditional marine product-rich diet.
Dewailly E et al. n-3 fatty acids and cardiovascular disease risk factors among the Inuit of Nunavik. The American Journal of Clinical Nutrition 74 (4): 464-73. Oct 2001.

Issue 72

CHEN and colleagues, Clinical Research Institute of Montreal, University of Montreal, Montreal, Quebec, Canada, investigated whether vitamins C and E influenced vascular structure and function in hypertension by modulating activity of NADPH oxidase and superoxide dismutase (SOD).
Background: Ascorbic acid (vitamin C) and alpha-tocopherol (vitamin E) have antioxidant properties that could improve redox-sensitive vascular changes associated with hypertension.
Methods: Adult, stroke-prone, spontaneously hypertensive rats (SHRSP) were divided into three groups: control (C; n=6); vitamin C-treated (vit C, 1000 mg/day; n=7); and vitamin E-treated (vit E, 1000 IU/day; n=8). All groups were fed 4% NaCl. Blood pressure (BP) was measured weekly. After 6 weeks of treatment, mesenteric arteries were analysed. Vascular O2- generation and NADPH oxidase activity were measured by chemiluminescence. Vascular SOD activity and plasma total antioxidant status (TAS) were determined by spectrophotometry.
Results: BP increased from 2127 to 2656 mm Hg in controls. Treatment prevented progression of hypertension (vit C, 2226 to 23414 mm Hg; vit E, 2209 to 22710 mm Hg). Acetylcholine-induced vasodilation was improved (p<0.05), and media-to-lumen ratio was reduced (p<0.05) in the treated group. O2– was lower in vitamin-treated groups compared with controls (vit C, 104 nmol/min/g dry tissue weight; vit E, 9.63.5 nmol/min/g dry tissue weight; C, 219 nmol/min/g dry tissue weight; p<0.05). Both vitamin-treated groups showed significant improvement in TAS (p<0.01). These effects were associated with decreased activation of vascular NADPH oxidase (vit C, 4610, vit E, 50, C, 7016 nmol/min/g dry tissue weight; p<0.05) and increased activation of SOD (vit C, 122, vit E, 81, C, 4.61 U/mg; p<0.05).
Conclusion: The results demonstrated that vitamins C and E reduced oxidative stress, improved vascular structure and function and prevented progression of hypertension in SHRSP. The authors concluded that the observed effects might be mediated via modulation of enzyme systems that generate free radicals.
Chen X et al. Antioxidant effects of vitamins C and E are associated with altered activation of vascular NADPH oxidase and superoxide dismutase in stroke-prone SHR. Hypertension 38 (3 Pt 2): 606-11. Sep 2001.

HEINECKE, Departments of Medicine and Molecular Biology and Pharmacology, Washington University School of Medicine, St. Louis, MO, USA, heinecke@im.wustl.edu, reviewed (44 references) evidence for a role of oxidized low-density lipoprotein (LDL) in atherosclerosis and the ability of vitamin E to augment antioxidant defence in humans.
Discussion: A wealth of evidence suggests that oxidized LDL may be of central importance in animal models of atherogenesis. In recent clinical trials, however, dietary vitamin E supplements have not consistently prevented cardiac events in humans with established coronary artery disease. Such mixed results have led many to question the role of LDL oxidation in human atherosclerosis, although this interpretation assumes that the doses of vitamin E used in the clinical trials inhibited lipid oxidation in vivo. In fact, there is remarkably little evidence indicating that those particular regimens effectively inhibit lipid peroxidation in healthy humans. Furthermore, evidence of increased oxidative stress was not a criterion for inclusion in the trials; therefore, vitamin E may have benefited only a subset of the participants. These uncertainties raise doubts about the ability of vitamin E to augment antioxidant defence mechanisms in vivo and leave many questions about LDL oxidation and atherosclerosis unanswered.
Heinecke JW. Is the emperor wearing clothes? Clinical trials of vitamin E and the LDL oxidation hypothesis. Arteriosclerosis, Thrombosis and Vascular Biology 21 (8): 1261-4. Aug 2001.
Comment: More definitive clinical studies, using dose regimens of vitamin E that have been shown to effectively inhibit lipid peroxidation in humans, would seem warranted.

GAYTAN and PRISANT, Section of Cardiology, Medical College of Georgia, Augusta, GA 30912-3105, USA, reviewed (178 references) available published research data on the efficacy and safety of popular nutritional supplements used to treat heart disease.
Background: The use of nutritional supplements in the treatment of cardiovascular disease is growing rapidly in the USA. Many substances are marketed with anecdotal claims of efficacy. Most have not been scientifically studied. Excitement exists in the lay press about the homocysteine hypothesis of coronary artery disease and vitamin cures.
Methods: The authors undertook a MEDLINE search and review of papers covering the study of popular nutritional supplements. Papers were limited to peer-review journals using patient series reports, double-blinded prospective studies, and population studies. The reviewers obtained a compendium of the available data and analysed each paper’s methodology.
Results: A review of the most popular and most studied oral nutritional supplements for the treatment of heart disease demonstrated relatively few well-founded indications for the widespread application of the nutritional substances, with the exception of bioflavonoids. Some modest effects on endothelial dysfunction were noted for vitamins C and E. Red wines and beers were also noted to be beneficial. The majority of nutritional substances either had no effect or were deleterious.
Gaytan RJ, Prisant LM. Oral nutritional supplements and heart disease: a review. American Journal of Therapeutics 8 (4): 255-74. Jul-Aug 2001.
Comment: It may be fair comment that nutritional supplements are not a universal panacea or cure for coronary heart disease; however, in light of the large body of clinical evidence demonstrating significant therapeutic effects of a wide variety of supplements, (there are 340 items about heart disease on Positive Health’s website alone!), it appears to be a bit rich to suggest that supplements may be harmful.

Issue 71

GOLDHAMER and colleagues, Center for Conservative Therapy, Penngrove, California, USA, dracg@att.net, investigated the use of medically supervised, water-only fasting as a method of normalizing blood pressure (BP) in hypertensive patients.
Background: Hypertension-related diseases are the leading cause of illness and death in industrially developed societies. Antihypertensive drugs are used extensively; however, dietary and lifestyle modifications are also effective in treating patients with hypertension. One such intervention is the use of medically supervised, water-only fasting as a safe and effective means of normalizing BP and initiating health- promoting behavioural changes.
Methods: 174 hypertensive patients with BP in excess of 140 mm Hg systolic, 90 mm Hg diastolic or both underwent a short prefasting period (approximately 2-3 days on average) during which food consumption was limited to fruits and vegetables, followed by medically supervised water-only fasting (approximately 6-7 days on average) and a re-feeding period (approximately 6-7 days on average) introducing a low-fat, low-sodium vegan diet.
Results: Almost 90% of patients achieved BP less than 140/90 mm Hg by the end of the treatment programme. The average reduction in BP was 37/13 mm Hg, the greatest decrease being in those with the most severe hypertension. Patients with stage 3 hypertension (systolic BP >180 mm Hg, diastolic BP >110 mm Hg, or both) had an average reduction of 60/17 mm Hg at the end of treatment. All those who were taking antihypertensive medication at entry (6.3% of the total sample) successfully discontinued use of medication.
Conclusion: Medically supervised water-only fasting appears to be a safe and effective means of normalizing BP and may assist in motivating health-promoting diet and lifestyle changes.
Goldhamer A et al. Medically supervised water-only fasting in the treatment of hypertension. Journal of Manipulative and Physiological Therapeutics 24 (5): 335-9. Jun 2001.
Comments: The results of this research study ought to be disseminated to every general practitioner, and the option of undergoing a medically supervised water-only fast ought to be suggested to every patient with raised blood pressure, prior to the usual prescription of beta-blockers or other blood pressure lowering drugs (calcium antagonists, diuretics or ACE inhibitors). Can you even imagine doctors offering this treatment to lower blood pressure? I’m afraid that we have such a long way to go before this could become a reality.

EGELAND and colleagues, National Health Screening Service, Research Department, P.O. Box 8155, 0033 Oslo, Norway, grace.egeland@isf.uib.no, explored whether cod liver oil (CLO) consumption was protective against coronary heart disease (CHD).
Background: Some have suggested that omega-3 fatty acid consumption may reduce the adverse effect of smoking on CHD risk.
Methods: The study population was a cohort of 52,138 men and women participating in a cardiovascular disease screening in Norway. At the time of baseline screening, carried out by the National Health Screening Service of Norway from 1977-83, subjects were aged 35-54 years. 42,612 (82%) of the subjects completed a dietary questionnaire.
Results: 12.5% of questionnaire respondents reported using CLO. At baseline, CLO users had lower triglyceride levels, adjusting for age, body mass index, time since last meal and income (p0.05). At December 1992, 639 deaths due to CHD had occurred among male participants and 118 among females. Overall, no effect of CLO consumption reported at baseline on CHD mortality was observed (Cox Proportional Hazards analyses: Hazard Ratio [HR], 1.0; 95% confidence interval [CI], 0.8, 1.3). In analyses stratified by smoking status, never smokers and current smokers showed non-significant beneficial associations between CLO use and CHD mortality (HR, 0.7; 95% CI, 0.4, 1.5; and HR, 0.8; 95% CI, 0.6, 1.2, respectively). However, among former smokers, a non- significant excess risk of CHD mortality was associated with CLO use (HR, 1.6; 95% CI, 0.9, 2.6). Smokers, regardless of their CLO use, were at a substantially higher risk of CHD mortality relative to non-smokers.
Conclusion: Omega-3 fatty acid [as CLO] supplementation, as practised in this cohort, provided no significant benefits to CHD risk among study participants.
Egeland GM et al. Cod liver oil consumption, smoking, and coronary heart disease mortality: three counties, Norway. International Journal of Circumpolar Health 60 (2): 143-9. Apr 2001.

Issue 69

RISSANEN and colleagues, Research Institute of Public Health, University of Kuopio, PO Box 1627, FIN-70211, Kuopio, Finland, investigated whether low serum levels of lycopene are associated with increased risk of acute coronary events and stroke in previously event-free middle-aged men.
Background: Several epidemiological studies have shown an association between beta-carotene and risk of cardiovascular diseases. Only a few studies have investigated the association of lycopene with the risk of coronary events. No studies have looked at lycopene in relation to risk of stroke.
Methods: 725 men aged 46-64 years, examined in 1991-1993 in the Kuopio Ischaemic Heart Disease Risk Factor Study, were evaluated in a Cox’s proportional hazard’s model, adjusting for examination years, age, systolic blood pressure and three nutritional factors (serum folate, beta-carotene and plasma vitamin C).
Results: 41 of the men had suffered either a fatal or non-fatal acute
coronary event or a stroke by December 1997. Men in the lowest quarter of serum lycopene levels (or =0.07 mol/l) had a 3.3-fold risk of acute coronary events (95% CI 1.7, 6.4) or stroke compared to the others.
Conclusion: The findings suggest that a low serum lycopene level is associated with an increased risk of atherosclerotic vascular events in middle-aged men previously free of coronary heart disease and stroke.
Rissanen TH et al. Low serum lycopene concentration is associated with an excess incidence of acute coronary events and stroke: the Kuopio Ischaemic Heart Disease Risk Factor Study. The British Journal of Nutrition 85 (6): 749-54. Jun 2001.

HAIDARI and colleagues, Cardiovascular Research Center, Tehran University of Medical Sciences, Tehran, Iran, mhaidari@sickkids.on.ca, investigated whether enhanced susceptibility of low-density lipoprotein (LDL) to oxidation and decreased vitamin E concentration in LDL were additional risk factors for atherosclerosis in Iranian patients with established coronary artery disease (CAD).
Background: Evidence indicates that oxidative modification of LDL is an important trigger in a complex chain of events leading to atherosclerosis.
Methods: 132 Iranian patients with angiographically confirmed CAD were examined and compared with 111 healthy Iranian control subjects. Susceptibility of LDL to copper-mediated oxidation was assessed by measuring conjugated diene production. Vitamin E content of LDL was measured by high-pressure liquid chromatography (HPLC).
Results: The mean lag time of LDL oxidation and LDL alpha-tocopherol/ LDL-cholesterol ratio were lower in patients with CAD than in controls (5514 min and 2.41.0 mmol/mmol, compared with 6313 min and 2.91.1 mmol/mmol; p<0.0001 and p<0.001, respectively). Multiple stepwise regression analysis showed the lag time (OR 1.96; 95% CI 1.34, 2.87; p<0.0001) and concentration of vitamin E in LDL (OR 1.65; 95% CI 1.16, 2.33; p<0.005) to be independent determinants of CAD. Significant inverse Spearman rank correlations were found between lag time (r=-0.285; p<0.001) or concentration of vitamin E in LDL (r=-0.197; p<0.002) and severity of CAD. Lag times were not significantly correlated with serum C-reactive protein or ferritin.
Conclusion: These data suggest that a short LDL oxidation lag time and a low concentration of vitamin E in LDL might be independent coronary risk factors for stable CAD in Iranian people.
Haidari M et al. Enhanced susceptibility to oxidation and diminished vitamin E content of LDL from patients with stable coronary artery disease. Clinical Chemistry 47 (7): 1234-40. 2001.

Comment: Both the above research studies demonstrate important associations between nutrients – lycopene and vitamin E – and risks of coronary heart disease and stroke.

Issue 68

ASHTON and colleagues, School of Biological Chemical Sciences, Deakin University, Burwood, Victoria, Australia, investigated the effects of replacing dietary lean meat with tofu on coronary heart disease (CHD) risk factors.
Methods: 45 healthy males aged 35 to 62 years were entered into a randomized, cross-over design, dietary intervention study. A diet containing 150 g daily lean meat was compared to one containing 290 g daily tofu (a soy product) in an isocaloric and isoprotein substitution. Each dietary period was 1 month. A 7-day diet record was used to monitor specific dietary characteristics.
Results: Three subjects were non-compliant and were excluded prior to data analysis. The diets were similar in terms of energy, protein, carbohydrate, total fat, saturated and unsaturated fat, polyunsaturated to saturated fat ratio, alcohol and fibre. Subjects on the tofu diet exhibited significantly lower total cholesterol and triglyceride levels compared with those on the meat diet, and the in vitro LDL oxidation lag phase was significantly longer on the tofu diet. Haemostatic factors (factor VII and fibrinogen) and lipoprotein(a) levels were not significantly affected.
Discussion: Replacement of dietary lean meat with tofu resulted in an increase in LDL oxidation lag phase, which one would expect to be associated with a decreased risk of CHD.
Ashton EL et al. Effect of meat replacement by tofu on CHD risk factors including copper induced LDL oxidation. Journal of the American College of Nutrition 19 (6): 761-7. Nov-Dec 2000.

MAXWELL, Department of Medical Sciences, The University of Edinburgh, Western General Hospital, UK, s.maxwell@ed.ac.uk, reviewed (22 references) the role of dietary antioxidants and plasma homocysteine levels in the pathophysiology of coronary artery disease (CAD) and vascular events.
Discussion: Only about two-thirds of clinical coronary events can be explained by traditional risk factors for CAD. Therefore, other nutritional and biochemical factors, such as dietary antioxidants and plasma homocysteine, may also contribute to the pathophysiology of CAD. Established risk factors such as hypertension, smoking and diabetes mellitus are all associated with increased oxidative stresses in the vascular wall, and may facilitate the development of vascular disease by: increasing oxidation of low-density lipoprotein particles; inactivating endothelium-derived nitric oxide; and exerting direct cytotoxic effects on endothelial cells. Protective antioxidant molecules include vitamins C and E. Epidemiological studies suggest that individuals with high circulating levels or dietary intake of natural antioxidant vitamins are protected against vascular disease events. Natural and synthetic antioxidants have also been shown to have beneficial effects on endothelial function and lipoprotein oxidation. However, large prospective randomized controlled trials examining antioxidant (mainly vitamin E) interventions have failed to show a reduction in mortality due to vascular events in high-risk individuals. One reason for this may be pro-oxidant effects of high-dose antioxidant supplements. Epidemiological studies over 30 years have shown that increased [plasma] levels of the amino acid homocysteine are associated with vascular disease. In recent years, homocysteine has been found to promote oxidant injury to the vascular endothelium and impair endothelium-dependent vasomotor regulation; it may also alter the coagulant properties of blood. Dietary supplementation with folic acid and B vitamins can reduce plasma homocysteine levels. Current studies are examining the impact of these vitamins in high-risk patients and may establish a causative role for homocysteine in vascular events.
Maxwell SR. Coronary artery disease – free radical damage, antioxidant protection and the role of homocysteine. Basic Research in Cardiology 95 (Suppl 1): 165-71. 2000.

DURRINGTON and colleagues, University Department of Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK, pdurrington@hq.cmht.nwest.nhs.uk, investigated the safety and efficacy of a concentrate of fish oil-derived omega-3 polyunsaturated fatty acids (PUFAs) in lowering blood triglyceride levels in patients with coronary heart disease (CHD) and persisting hypertriglyceridaemia.
Background: Omega-3 fatty acids have been reported to prolong life in patients who have suffered myocardial infarction (MI). To date, doses of such fatty acids that have been used in clinical trials investigating their effects on coronary endpoints have only had minimal triglyceride-lowering effects.
Methods: In this double-blind clinical trial, 59 patients with CHD receiving simvastatin (10-40 mg daily), with serum triglycerides >2.3 mmol/L, were randomized to receive 2 g daily Omacor (an 84% concentrate of omega-3, long-chain PUFAs from fish oil) or placebo for 24 weeks. At the end of the double-blind trial, 46 patients continued on open active treatment for a further 24 weeks.
Results: Patients on Omacor showed a sustained significant 20-30% decrease in serum triglycerides (p<0.005) and a 30-40% decrease in very low-density lipoprotein (VLDL) cholesterol (p<0.005) at 3, 6 and 12 months compared with baseline or placebo. Omacor had no deleterious effects on low-density (LDL) or high-density lipoprotein (HDL) cholesterol or in biochemical and haematological safety tests. Omacor did not have any adverse effect on glycaemic control in patients with diabetes. Patients with diabetes taking Omacor showed a decrease in serum triglyceride levels that was at least as great as that seen in non-diabetic patients. One patient on placebo died of an acute MI. Three patients (two on placebo and one on Omacor) withdrew from the trial. Omacor was generally well tolerated.
Discussion: The results showed Omacor to be a safe and effective treatment for lowering serum triglycerides over 1 year in patients with CHD and persisting triglyceridaemia despite simvastatin treatment.
Durrington PN et al. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. Heart 85 (5): 544-8. May 2001.

Comments: Following several decades of research and many types of dietary interventions, it has become almost commonplace knowledge that dietary and lifestyle approaches can significantly improve outcome for heart disease patients. The research continues to flesh out the evidence; it is hoped that these results become incorporated into clinical practice, which would obviate the need for patients to take drugs with severe side effects and risks.

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