The Annals of Cardiology No.41 | Fish Oils and Triglycerides
Did Granny pinch your nose and force you to swallow cod liver oil every morning? Chances are she thought it would protect you from rickets, a disease that makes children bow-legged. She was right – cod liver oil is rich in Vitamin D, which helps you absorb calcium and phosphorus from food, thereby keeping bones strong. I doubt, however, that Granny told you that cod liver oil also contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – two omega-3 fatty acids that lower triglyceride levels and protect you from heart attacks and strokes. This little nugget has made fish oils one of 2020’s most talked about medical interventions, thanks to the December 2019 FDA-approval of a pill named Vascepa.
Let’s take a step back. I bet you have a rough idea of your cholesterol level, but when was the last time you asked your doctor about your triglycerides? Cholesterol is a building block for cell membranes, and it’s also used to make hormones – your blood levels depend on how much your liver makes and how much cholesterol you eat. Too much can clog arteries. Triglycerides, on the other hand, are straight fat – they store calories for use as energy. Most fat we eat is already in triglyceride form – things like butter, margarine, and oil. Your liver also converts excess carbohydrates into triglycerides, which are then stored as fat. That’s why eating a low fat, high carbohydrate diet can still make you… well, fat. That’s one reason why knowing your blood triglyceride levels is important.
Here’s another reason: a year ago, a study was published in the New England Journal of Medicine which sought to answer the question of whether lowering triglyceride levels could reduce the chances of having a heart attack or stroke. It was called the REDUCE-IT trial, and it enrolled 8179 patients in 11 countries who had coronary artery disease or diabetes with other coronary risk factors (e.g., high blood pressure, smoking, sedentary lifestyle). All patients were already taking a statin, and their triglyceride levels were 135-499 mg/dL. Patients were assigned to receive either a highly purified fish oil capsule (Vascepa) or a placebo. After one year, patients receiving Vascepa had an 18% reduction in triglyceride level, whereas patients receiving placebo had a 2% increase. The startling finding, however, was that after 5 years, patients taking Vascepa had a 25% reduction in risk of heart attack, stroke, and death.
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