Gang--FYI

se of fish oil in ICD patients warrants caution: Meta-analysis

January 21, 2008 Michael O'Riordan
Toronto, ON - A small meta-analysis published last week, which attempted to address the
inconsistencies in the data on fish-oil supplementation in patients with implantable
cardioverter defibrillators (ICDs), suggests that there is significant heterogeneity in cardiac
patients' responses to the long-chain fatty acids. [1]

Published in the January 15, 2008 issue of the Canadian Medical Association Journal, the
researchers, led by Dr David Jenkins (University of Toronto, ON), say the reasons for
observed differences in response are not clear, but conclude that "caution should be used
when prescribing fish-oil supplementation for patients with ventricular tachycardia. "

The meta-analysis included three trials presented and published in the past few years, all
reported by heartwire: the Study on Omega-3 Fatty Acids and Ventricular Arrhythmia
(SOFA) [2], a trial showing that supplementation with fish-oil capsules over one year did
not reduce the risk of ventricular tachycardia/ ventricular fibrillation (VT/VF) or death in
patients with secondary-preventio n ICDs; a study by Dr Merritt Raitt (Oregon Health and
Science University, Portland) showing that the use of fish-oil supplements over two years
failed to protect against VT/VF in patients who had received an ICD because of recent
sustained ventricular arrhythmia [3]; and a study by Dr Alexander Leaf (Harvard Medical
School, Boston, MA) and colleagues showing that regular ingestion of fish-oil fatty acids
for 12 months failed to reduce the risk of potentially fatal ventricular arrhythmias in
patients with secondary-preventio n ICDs [4].

In the study by Leaf and colleagues, however, an "on-treatment" analysis hinted that there
was a longer time to first ICD event for VT/VF or death from any cause among patients
randomized to fish oil than among those randomized to olive-oil placebo.

Meta-analysis of ICD discharge in studies of fish-oil supplementation

Study
Relative risk (95% CI)
p value for heterogeneity
Overall
0.93 (0.70-1.24)
0.04

To download table as a slide, click on slide logo below
The meta-analysis of ICD discharge in the three studies of fish-oil supplementation
showed that the prescription of fish oil to these patients failed to reduce arrhythmia. In a
meta-analysis of all-cause mortality, an outcome common to all three studies, the overall
relative risk was nonsignificant.

Jenkins and colleagues point out that two other meta-analyses failed to "show a clear
advantage of increased fish-oil consumption, either for secondary prevention of coronary
heart disease or restenosis after angioplasty. " They note, however, that fish oils have
complex and pleiotropic effects on the heart," including blocking cardiac ion channels,
reducing fibrosis in response to mechanical stress, decreasing blood coagulation, reducing
serum triglycerides, and possibly altering immune function." Moreover, drug-nutrient
interactions, such as fish oil with antiarrhythmic medications, might be partly responsible
for the observed differences between studies.

They conclude by stating that further research is needed, but, "at present, the use of fish
oils in patients with implantable cardioverter defibrillators appears to warrant caution."

This report is so stupid as to be humerous. Fish oil has never been touted, to my knowledge, as a treatment for ventricular arrhythmia.
Ventricular arrhythmia is caused by rogue cells in the heart wall ( myocardium). Fish oil will never repair those cells. Fish oil does several things. It reduces cholesterol and more importantly, reduces tryglycerides. This is important for heart health.

As arrhythmia patients we should not lose sight of the fact that arrhythmia is not our only problem. We must be congnizent of our overall heart health. Fish oil promots heart health. No supplement is going to heal the scars on my myocardium that cause the arrhythmia. They may promote heart health that will reduce my reduce my chances of a myocardial infarction (heart attack).

Arrhythmia is not our only challenge to staying alive. Anything that promotes heart health is to our advantage.

BTY, I take 2000 mg of fish oil a day. My cholesterol is down and my tryglycerides are down. Make your own decision. Please don't be swayed by this inane study.

don

Thank you Don. My primary care doctor told me to take the Omega Fish Oil pills to get control of my triglycerides. I take 3 pills a day of 1000mg each. I will seen the doctor in a couple of weeks and will let you know what some of my reports are. Keeping my sugar under control is my main concern right now. The heart seems to be doing o.k. Judy

I agree with Don. My last total cholesterol reading was 170. I've been taking fish oil for about 4 years per my cardologist. I also take vitamin C. When I first had my MI, my cardiologist had me take niacin and vitamin E along with the vit. C. But he changed me to fish oil for the same reason Don and Judy take it. Works for me.

It's good to see you back on the forum, Don. I missed your sage advice. I looked up several of the meta analyses until I found out that a meta analysis is only a rehashed study of a prior study. Guess some doctors just have to keep their names out front like all our politicians do. One must take all the studies with a large grain of salt.

Bill

Just FYI, I have been taking fish oil and glucosamine for several months as per my doctor's suggestion for osteoarthritis in my hands. One or the other of these two supplements has done wonders. I have much more mobility and far less swelling. Don't know if it is helping or hurting my heart, though . . . . . .

Guess we shouldn't be posting articles here.

Bob,

Posting articles isn't a problem, as far as I know. I didn't mean to disparage your post. Sorry. I only meant that we need to peruse all studies with a jaundiced eye because some are embellished to say the kindest thing.

I don't post articles because I'm lazy. I just post the URL.

Keep posting. All are welcome.

Bill

Posting articles is done here quite often. Doing so can be valuable as it gives others with similar problems a chance to read, consider and remark on the article.

It is a good idea to also post the source of the article. An article from a scientific review might have more value to the reader than an article from the New York Post.

don

I recently started on a daily dosage of 2400mg-fish oil/omega 3. I read a study that suggests that this is not necessarily a good idea for some icd users. I will seek more online views, consult the primary care and cardio and implant docs, and talk to Medtronic before making any changes. I also take other supplements and will search for reported problems of the same nature. No need to spend all that money on supplements if they are not helping you or even comprimising your health.

I started 4 1000mg Fish oil jell pills a couple of years ago after a normal physical. My wife was told to take 5 of them daily to lower her triglycerides and cholesterol numbers. I still had the heart attack but understand it was my habits of the 40-50 years prior. My cholesterol numbers are very good as the combined are now at 90. Yesterday the Cardiologist said I should continue my same group of meds and supplements. My regular MD had requested that I stay on the Fish oil also when I had my physical in August. Unless I hear something more current or the docs say to stop I'm staying with the fish oil.
Footnote is that I could eat salmon almost daily if I could.