Jay S. Cohen M.D.       http://medicationsense.com      1337 Camino Del Mar   Suite C       Del Mar, CA 92014       Phone: 858.345.1760       Fax: 858.509.8944


OMEGA-3 OILS PREVENT SUDDEN CARDIAC DEATH

The Sudden Deaths of Sports Heroes John Unitas, Dave DeBusschere, and Darryl Kyle Should Have Raised Awareness That Most of the 250,000 Sudden Cardiac Deaths Annually Can Be Prevented with Fish Oils
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Why We Keep Missing the Message.

On June 22, 2002, Darryl Kile, All-Star pitcher for the St. Louis Cardinals, suffered a heart attack and died alone in his hotel room. He was 33.

On July 22, 2002, Prince Ahmed bin Salman of Saudi Arabia, the owner of War Emblem, which won the 2002 Kentucky Derby and Preakness, and of Point Given, the 2001 horse of the year, died shortly after a heart attack. He was 43.

On September 11, 2002, Johnny Unitas, legendary quarterback and, in some experts' opinion, the greatest football player ever, died suddenly while working out near Baltimore. He was 69.

Could these deaths, and 250,000 others like them that occur every year in America, have been avoided? In the majority of cases, yes.

Sudden cardiac death (SCD) is a huge and very common problem that "accounts for about 50% of cardiovascular mortality in developed countries," according to the European Heart Journal (1). Cardiovascular death is the #1 killer in the U.S. and other western countries.

If you consider yourself safe because your cholesterol levels are low and you have no heart problems...don't. Half of all SCD -- 125,000 deaths annually in the U.S. alone -- occur in people with no history of heart disease. SCD usually occurs without early warning, away from hospitals. Death comes quickly, usually within minutes or hours.

What causes SCD? The common belief is a massive heart attack. In fact, heart attacks may trigger SCD, but they usually aren't the actual killers. What is? Cardiac arrythmias: disruptions in the heart's electrical system that makes the heart rhythm unstable and ineffective.

What can you do? A lot -- and quite easily -- fortunately. Just two months before Kile's death, newspapers and TV news reported three impressive studies published almost simultaneously in respected medical journals. The April 11, 2002, New England Journal of Medicine stated:


"The omega-3 fatty acids found in fish are strongly associated with a reduced risk of sudden death among men without evidence of prior cardiovascular disease." In this study, men with the highest levels of omega-3 fatty acids had an 81% lower risk of sudden death than men with the lowest levels (2).

Similar findings were reported in studies in Circulation (3) and JAMA (involving women)(4).


The Media Drops the Ball
So when Darryl Kile died two months later, reporters asked about his diet, right? No. Well, they asked whether he ate fish or took omega-3 fish oil supplements, right? No.

But aren't these obvious questions? Yes. Indeed, Kile's father died from heart disease at age 44, so reporters did ask whether Kile's cardiac risk should have been assessed and if, perhaps, Kile should have been taking cholesterol-lowering statin drugs. But no one mentioned fish oils.

How about after bin Salman and Unitas suffered SCD? Did anyone ask about their nutrition? No. Why not? The failure of intelligent reporters to ask such obvious, important questions is symbolic of the disconnect in our consciousness about medical problems. In a rational healthcare system, we'd consider nutrition solutions first, natural supplements second, and drugs third and last. But drugs get the major play in news reports, and the drug industry's huge profits are fueled into pervasive drug advertising to dominate our awareness, so drugs are our first consideration while natural, safer, proven-effective solutions are ignored.

It's as if we cannot believe that nutritional interventions could be as powerful as pharmaceutical ones. That's exactly what the drug industry wants us to believe, and that's exactly how doctors act. But consider the numbers. Statins, so highly touted by mainstream medicine, reduce cardiac mortality 25%-33%. Fish oils reduce SCD 40%-80% -- and have many other benefits as well. These numbers aren't directly comparable, but they do indicate the importance of fish oils in cardiac health.

Fish Oils Vs. Statins
So why do statins make headlines while fish oils are ignored? Why have doctors made the statins Lipitor and Zocor the #1 and #2 best-selling drugs in America, yet hardly ever mention fish oils to patients?

And aren't doctors supposed to practice with the philosophy of "Do No Harm?" Statins cause side effects in 15%-35% of patients (5-8). Some side effects (liver failure, severe muscle injury, kidney failure, nerve injuries), albeit infrequent, are serious.

In contrast, fish oils are nutrients our bodies need to function properly and ward off disease. Fish oils reduce triglyceride levels, and when taken with a small amount of gamma-linoleic acid (GLA, an omega-6 fatty acid), reduce LDL levels, too. Omega-3 oils improve glucose metabolism, reduce insulin reactivity, improve vascular flexibility and reduce blood pressure. In addition, fish oils appear to help prevent cancer of the breast, colon, and prostate.

Other contrasts: statins cost about $100/month; fish oils, about $15. Fish oils have few if any side effects. The only one mentioned is a possible reduction in platelet clumping, which usually is a benefit. But if you take anticoagulants (warfarin, Coumadin), you shouldn't use fish oils. And if you take aspirin, check with your doctor.

The issue here isn't whether fish oils are better than statins. Fish oils and statins do very different things. Statins are extremely important drugs that benefit millions of people. Indeed, many of the millions of people taking statins might benefit even further by the addition of omega-3 fatty acids (ask your doctor). Thus, the point is that fish oils deserve equally widespread recognition as a major factor in maintaining everyone's cardiovascular health.

One of Our Most Important Cardiac Therapies
Overall, I would argue that fish oils are one of our most beneficial cardiac therapies. Indeed, the three journal articles in May were hardly new findings. We began learning about fish oils in the late 1970s, when studies showed that Eskimos, despite fat-laden diets, had substantially fewer heart attacks than westerners. The observation that fish oils might be beneficial launched a new field of research, as described in the 2000 Mayo Clinic Proceedings:


"These observations generated more than 4,500 studies to explore this and other effects of omega-3 fatty acids on human metabolism and health. From epidemiology to cell culture and animal studies to randomized controlled trials, the cardioprotective effects of omega-3 fatty acids are becoming recognized (9)."


Such recognition has come slowly. The most impressive study, a large, placebo-controlled Italian study (GISSI), was published in Lancet in 1999. More than 11,000 people with recent heart attacks were given 1 gram/day of omega-3 oils or placebo for three and a half years. The omega-3 group had significantly fewer heart attacks and strokes, 45% fewer cardiac deaths, and 20% fewer deaths from all causes (10).

Unfortunately, most Western diets are deficient in omega-3 fatty acids. Experts recommend about 3 grams of omega-3s daily, but the average U.S. intake is only 1.6 g/day (6). Over the years, people become more and more deficient -- and more and more vulnerable to a host of diseases including SCD. Thus, Dr. Christine M. Albert, chief of cardiology at Massachusetts General Hospital and chief investigator of the New England Journal study advised, "The higher your blood level of omega-3, the lower your risk (11)."

The type of fish oil you get is as important as the amount. Eat fatty, ocean fish (salmon, swordfish, sardines, fatty tuna) twice a week. Or take 2-3 grams of fresh, high-quality fish oil capsules daily.

Learning from Prior Experience?
The premature deaths of Darryl Kile, Ahmed bin Salman, and John Unitas were tragedies -- likely preventable tragedies. So are the majority of the 700 sudden cardiac deaths that occur every day in America and thousands of others occurring worldwide. Will they be prevented? On May 14, 2003, Dave DeBusschere, All-Star forward for the New York Knicks championship teams of the 1970s, suffered a heart attack on a lower Manhattan street and died soon afterward. He was 62. None of the reports I saw mentioned his diet or whether he got enough fish oils. Another lesson lost.

So you have to be your own researcher today. Doctors' education is slanted toward drugs. Once practicing, most doctors' information about treatment comes from the drug industry. Most doctors sincerely want to help their patients, but their perspective is narrow and their knowledge of nutritional interventions is scant. And the healthcare system today affords doctors little time to do their own research into better therapies.

Therefore, it isn't surprising that doctors know so much about statins, yet so little about fish oils. This bias is symptomatic of an overly drug-oriented medical system that favors drugs over scientifically-sound nutrition-based therapies. When a new statin study is published, it's manufacturer has a well-oiled PR department to spread the word to the media, and thousands of drug sales representatives to use the study to impress doctors. But there's no big money or PR machine backing nutritional therapies.

Thus, unfortunately, you cannot rely on most doctors or the media today for a balanced picture. Studies have shown that less than 10% of patients visiting their doctors receive enough information to fulfill their right of informed consent (12). And while even marginally meaningful statin studies make headlines, studies about fish oils possibly reducing the risk of Alzheimer's disease are relegated to the back pages (13). So you must inform yourself. And while you're doing it, inform your doctor about fish oils for preventing SCD, so that perhaps he/she can inform the people following you.

References
1. de Lorgeril, M, Salen, P, Defaye, P, et al. Dietary prevention of sudden cardiac death. European Heart Journal 2002;23:277-285.
2. Albert, CM, Campos, H, Stampfer, MJ, et al. Blood Levels of Long-Chain N-3 Fatty Acids and the Risk of Sudden Death. New England Journal of Medicine 2002;346(15):1113-18.
3. Marchioli, R, Barzi, F, Bomba, E, et al. Early Protection against Sudden Death by N-3 Polyunsaturated Fatty Acids after Myocardial Infarction. Circulation 2002;105:1897-1903.
4. Hu, FB, Bronner, L, Willett, WC, et al. Fish and Omega-3 Fatty Acid Intake and Risk of Coronary Heart Disease in Women. JAMA 2002;287(14):1815-21.
5. Physicians' Desk Reference, 55th Edition, Montvale, N.J.: Medical Economics Company, 2001.
6. Wierzbicki, AS, Lumb, PJ, Semra, Y, et al. Atorvastatin compared with simvastatin-based therapies in the management of severe familial hyperlipidaemias. Qjm 1999;92(7):387-94.
7. Bertolini, S, Bon, GB, Campbell, LM, et al. Efficacy and safety of atorvastatin compared to pravastatin in patients with hypercholesterolemia. Atherosclerosis 1997;130(1-2):191-7.
8. Marz W, Wollschlager H, Klein G, et al. Safety of low-density lipoprotein cholestrol reduction with atorvastatin versus simvastatin in a coronary heart disease population (the TARGET TANGIBLE trial). American Journal of Cardiology 1999;84(1):7-13.
9. O'Keefe, JH Jr, Harris, WS. From Inuit to implementation: omega-3 fatty acids come of age. Mayo Clinic Proceedings 2000;75(6):607-14.
10. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999;354(9177):447-55.
11. Grady, D. More Support for Eating Fatty Fish. New York Times, 4/10/2002:www.nytimes.com.
12. Braddock, CH, Edwards, KA, Hasenberg, NM, et al. Informed Decision Making in Outpatient Practice: Time to Get Back to Basics. JAMA 1999;282:2313-20.
13. Associated Press. For seniors, eating fish may cut risk of Alzheimer's. Los Angeles Times, July 22, 2003.





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