Fish Oil's Role in Coronary Artery Disease Prevention and Treatment

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• Fish Oil and Cholesterol Reduction
• Secondary Prevention of Heart Disease with Fish Oil
• Safety of Fish Oil Use in Heart Disease
• Clinical Trials on Fish Oil and Heart Health
• Impact of Fish Oil on LDL Particles
• Full Transcript

Fish Oil and Cholesterol Reduction

Dr. Kevin Barrows, MD, emphasizes that fish oil is effective in lowering triglycerides, a type of fat in the blood, which is crucial for heart health. Omega-3 fatty acids in fish oil can improve the lipid profile, making it comparable to pharmaceuticals in treating hypertriglyceridemia. This natural approach can be a valuable addition to traditional cholesterol-lowering strategies.

Secondary Prevention of Heart Disease with Fish Oil

Dr. Kevin Barrows, MD, discusses the potential of fish oil in secondary prevention of coronary artery disease, particularly after a heart attack. While medications like aspirin, statins, and beta blockers are standard, fish oil has shown benefits in reducing mortality and sudden cardiac death. However, its additional benefits when used with these medications remain under investigation.

Safety of Fish Oil Use in Heart Disease

According to Dr. Kevin Barrows, MD, fish oil is generally safe with minimal side effects, making it a favorable option for heart disease patients. While ongoing research is necessary to ensure its safety, the low risk of adverse effects supports its use in integrative medicine for heart health.

Clinical Trials on Fish Oil and Heart Health

Dr. Anton Titov, MD, references a Finnish clinical trial that demonstrated the benefits of increased fish consumption on cholesterol composition. The study highlighted subtle improvements in lipid fractions beyond standard laboratory measures, suggesting broader cardiovascular benefits from fish oil and dietary fish.

Impact of Fish Oil on LDL Particles

Dr. Kevin Barrows, MD, explains that fish oil can alter the composition of LDL particles, making them larger and more buoyant. Larger LDL particles are less likely to contribute to atherosclerosis compared to smaller, denser particles. This nuanced effect underscores the importance of understanding fish oil's role in cardiovascular health.

Full Transcript

Dr. Anton Titov, MD: How to use fish oil for coronary artery disease treatment? How does fish oil lower cholesterol? How can it prevent a second heart attack through integrative medical treatment? What is the role of fish oil in the secondary prevention of heart disease? How safe is fish oil for coronary artery disease? How do omega-3 fatty acids change the lipid profile? How does fish oil improve the cholesterol profile? Are there problems in using fish oil for heart disease prevention? How does fish oil help to lower high triglycerides?

Dr. Kevin Barrows, MD: Yes, it is absolutely unequivocal that fish oil lowers triglycerides. The research is very strong that fish oil can help to treat hypertriglyceridemia. Fish oil is equal to pharmaceuticals in lowering triglycerides. There is even an FDA-approved version of fish oil for the treatment of hypertriglyceridemia. It is more controversial whether fish oil can be used in the secondary prevention of coronary artery heart disease.

We have good medications today for the secondary prevention of heart disease. Secondary prevention is the prevention of a second heart attack after the first heart attack has already happened. We have aspirin, statins, ACE inhibitors, and beta blockers. Now these effective medications have become the standard of care to prevent second heart attacks. But before that era, fish oil showed a very large benefit for reducing mortality after a heart attack. Fish oil reduces sudden cardiac death and myocardial infarction.

Today, all these powerful medications, aspirin, beta blockers, ACE inhibitors, and statins, are used in many patients to prevent second heart attacks. Does fish oil have additional benefits in patients who already take these powerful medications? We do not yet have an answer to that question. The good news is that fish oil has almost no side effects. We have to continually study fish oil to make sure there are no adverse effects. But we use fish oil readily in patients with heart disease.

Sometimes the medicine is very toxic or risky. You need good evidence before you give this medicine to a patient. You have to be sure that the benefits of using this medicine are stronger than the risks of toxicity. We would love to have impeccable evidence of safety for all natural medicines. But sometimes the medicine is very safe. Then you could argue that you probably don't need to be hesitant to use natural medicine. Because there is often no harm in using many natural medicines, like fish oil.

Dr. Anton Titov, MD: There is a clinical trial from Finland that looked at the benefits of adding more fish, white fish, to the regular diet. The additional amount of fish that patients ate was not significant. Nevertheless, scientists showed that those patients who ate more fish had beneficial effects on their cholesterol composition. Importantly, the benefits of eating more fish were not so much in levels of total cholesterol, LDL, and HDL fractions of cholesterol. These are cholesterol fractions that are typically measured in the laboratory.

Benefits from eating more fish were more subtle and went beyond standard lipid fractions. Health benefits were seen in the relative ratio of cholesterol and lipid fractions. These fractions could only be measured by research-grade methods. There are multiple classes of lipid particles in the body. Cholesterol metabolism is very complex. So this clinical trial probably speaks to the benefits of using more fish and more fish for heart disease prevention.

Dr. Kevin Barrows, MD: I think you are correct. This is one of the mechanisms by which fish oil is beneficial for the cardiovascular system. Fish oil changes the composition of LDL. Sometimes you use fish oil, and your LDL goes up a little bit because you are ingesting fish oil, which is a fat. Sometimes you eat enough fish oil, and you can actually increase your LDL levels. But if you fractionate the LDL particles, you will see that the character of LDL particles changed. LDL particles became larger and more buoyant. We know that larger LDL particles are less atherogenic than the small dense LDL particles.

Dr. Anton Titov, MD: So the details matter.

Dr. Kevin Barrows, MD: That is correct! Fish oil for coronary artery disease and high cholesterol. What are the nuances of fish oil use in heart disease secondary prevention?