Fish Oil (Omega 3 fatty acids has been touted as a having heart and vascular protective effects for many years. In 2018, a number of large clinical studies including studies in people with diabetes showed that fish oil had little to no effect in reducing cardiovascular events. This was quite disappointing to doctors and patients alike and many stopped taking fish oil.
- Then in 1/19 a large study called the Reduce-It Trial was published in the New England Journal of Medicine. It looked at the effect of an Omega 3 fatty which was a specific component of fish oil—EPA or icosapent ethyl in people with known heart disease and/or diabetes. Let me tell you a bit about the people enrolled in the study. The study included people who were 45 years of age or older with known heart disease OR who were 50 years of age or older and diabetes mellitus and at least 1 additional heart risk factor.
- They had to have a fasting triglyceride of 150-499 mg/dl and their cholesterol had to be already well controlled on a statin. The LDL cholesterol at the start of the study was really very controlled and was in the mid 70’s.
- The study went on for 5 years. The remarkable finding was that the icosapent ethyl reduced cardiovascular death, heart attack and stroke considerably. This was phenomenal news to those of us who every day, treat people with heart disease and heart disease risk.
In summary, in the past year, we learned that regular fish oil doesn’t have the heart disease reduction effect that was claimed but that a specific derivation of fish oil, the omega 3 fatty acid icosapent ethyl (only available by prescription) reduces cardiovascular death and heart attacks and strokes in the people described above.
We at Texas Diabetes and Endocrinology continually strive to be current and at the forefront of using interventions to reduce heart attack and stroke risk. We are experts in diabetes and heart risk factor management. One of our doctors and one of our clinical nurse specialists, Ashley Davila CNS, are boarded in Lipidology. We are also members of the National Lipid Association. We perform noninvasive heart disease risk assessments with an easy ultrasound based arterial assessment called Carotid Intimal Medial Thickness (CIMT). We also obtain “advanced lipid tests” in many individuals to help in their cardiovascular risk reduction/prevention.
We have participated in many clinical research studies evaluating a number of medications used to lower cholesterol. We are soon enrolling a study to evaluate the effect of a medication on lowering Lp(a) also called lipoprotein little a, which is an important indicator of heart attack and stroke risk. If you or any of your family has been told that you have an elevated Lp(a), please call our office and ask for the research department.
Despite great strides in health care, heart disease remains the number one cause of death in the United States. Individuals with diabetes are three times more likely to develop heart disease, heart attack or stroke than someone without diabetes. We at TDE take this very seriously and work with our patients to reduce their cardiac risk. Of course the best approach to healthcare is prevention: maintaining an optimal weight, engaging in regular exercise and enjoying a healthy diet low in saturated fats. However, when cholesterol can’t be controlled with lifestyle changes alone, statins are an excellent option.
Statins such as Lipitor and Crestor have been researched extensively with studies showing a powerful reduction of LDL (bad) cholesterol (20-60%) and more importantly, a significantly reduced risk of heart attack and stroke. Statins reduce production of LDL cholesterol and triglycerides and can increase HDL (healthy) cholesterol levels. Statins have also been shown to have anti-inflammatory properties and may reverse damage from atherosclerosis in some cases. Further studies have suggested a connection between statin use and a decreased risk of developing some forms of dementia as well as improved outcomes in patients with heart failure and cardiac bypass surgery. The American Diabetes Association recommends statins for individuals with known cardiovascular disease, prior heart attack or stroke, high levels of LDL and those with diabetes between the ages of 40 and 75 years.
What is the impact of statins on blood sugar?
The news recently reported the results of a study linking the use of statins to an increased risk of diabetes. This is of course a concern as the goal of statin therapy is to reduce risk. It is true that statins can cause a mild increase in blood sugars in some individuals and bears watching. However, given the cardiac benefits, the American Diabetes Association issued the following statement, “The clear benefits of statins on cardiovascular disease likely outweigh any potential detrimental effects on glucose metabolism and diabetes risk.” A representative from the Food and Drug Administration stated, “Clearly we think that the heart benefit of statins outweighs this small increased risk.”
What about side effects?
Side effects are an important consideration whenever starting a new medication. Studies have suggested that adverse side effects occur less often with statins than with most other classes of cholesterol lowering medications. The most common side effect is muscle soreness. This can be related to the dose of the statin or vary with the type of statin being used. We also follow liver enzymes in patients taking statins as these markers can rise in some people. Most patients tolerate these medications very well and the American Association for Clinical Endocrinologists continues to recommend statins as the preferred treatment for cholesterol reduction. When starting any medication it is important to discuss the risks and benefits with your health care provider.