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Where have all the omega-3 fatty acid results gone?

By Dr. Barry Sears

There has been a flurry of recent clinical trials that suggest supplementation with omega-3 fatty acids has no benefit in treating heart disease. Yet before 2005, the clinical trials using omega-3 fatty acids demonstrated an incredibly robust cardiovascular benefit. What happened? The answer may be widespread use of statins.

The benefits of omega-3 fatty acids come from reducing the generation of pro-inflammatory eicosanoids derived from arachidonic acid (AA). It is these inflammatory eicosanoids that cause cellular inflammation that leads to the rupturing of pre-existing plaques in the artery. Of the two omega-3 fatty acids in fish oil, the most important in preventing the formation of AA-derived eicosanoids is eicosapentaenoic acid (EPA). Since 2005 virtually every cardiovascular patient is usually prescribed statins. Unfortunately, statins are the only drugs known to medical science to increase AA formation. So in an effort to reduce cholesterol by taking statins, the patients were also increasing their AA levels. The increased use of statins may have simply overwhelmed the benefits of EPA. Or maybe if you use statins, there is no need for omega-3 fatty acids because the statins are truly wonder drugs.

This potential dilemma was answered in the largest cardiovascular ever done, the JELIS study in Japan. In this study, 18,000 cardiovascular patients were all put on statins. So if the statins were that powerful, then adding extra omega-3 fatty acids should have no benefit. Then half of the patients were given extra EPA and the other half olive oil. After 3 ½ years, those on the statins and EPA had 20% fewer cardiovascular events compared to those on the statins and olive oil. Further analysis indicated the reduction in the AA/EPA ratio in the blood was the strongest predictor of improved cardiovascular health. This indicates that if you are giving a drug that increases the AA/EPA ratio but not giving enough omega-3 fatty acids to significantly lower the AA/EPA ratio into a therapeutic zone, then you should expect no positive results in cardiovascular patients. That's exactly what has happened in the clinical results (except for the JELIS study) that have been published since 2005. If you really want to lower your cardiovascular risk, then reduce your AA/EPA ratio in the blood. If you are going to take statins, then plan to add even more omega-3 fatty acids to reach your goal. Your heart will thank you.