Dad's got atherosclerosis - what to do?

[Guest guest]

> The fish oil, statistically, is associated with a benefit in secondary

> prevention trials, i.e. those with established heart disease. But

> there's no evidence for prevention in the general population, from the

> preliminary look I've done. It's possible I'll change my mind as I

> read more so don't take this as the final word.

So, the evidence in general indicates that fish oil (n-3) benefits patients with

*any*

established heart disease, whereas the GISSI trial only indicated benefit for

those with left

ventricular function and those on beta-blockers (probably prescribed for

arrhythmia)?

Does pre-existing heart disease include those who've had a scan and found they

have

atherosclerosis? Or is it only people who've had heart attacks or strokes?

I like most of Dr. 's program (CoQ10, vitamin D, low carb) but I'm still

uncertain about

the fish oil. I'm pretty convinced it's not a good idea for the general

population, but Dr.

cites studies on his blog which indicate that n-3s can slow and even

reverse the

progress of atherosclerosis. I haven't reviewed these studies yet, so I don't

know if they're

legit.

Chris

[Guest guest]

A study on L-arginine for patients who had already had a heart attack was

stopped early

because too many patients died and the treatment was showing little benefit on

heart

function otherwise.

http://www.ncbi.nlm.nih.gov/pubmed/16391217

[Guest guest]

> If the study indicating that n-3 fats increase the risk 8-fold is true, we

have yet another

> major crisis on our hands.

The study by Burr et al I believe M originally mentioned used a 2x2

design, with a

control group, a dietary advice group, a fish advice group, and a group given

both forms

of advice. Adherence in the dietary advice group was boor, but blood tests for

EPA show

more adherence for the fish or fish oil group. The patient population had

angina, a "

painful constriction or tightness somewhere in the body " .

Deaths were indeed higher for the treatment group, but the relative risk was not

eight-

fold. These results need to be considered among the other, positive results for

fish oil, for

patients with various forms of cardiovascular disease.

" All-cause mortality was not reduced by either form of advice, and no other

effects were

attributable to fruit advice. Risk of cardiac death was higher among subjects

advised to

take oily & #64257;sh than among those not so advised; the adjusted hazard ratio

was 1.26 (95%

con & #64257;dence interval 1.00, 1.58; P ¼ 0.047), and even greater for sudden

cardiac death

(1.54; 95% CI 1.06, 2.23; P ¼ 0.025). The excess risk was largely located

among the subgroup given & #64257;sh oil capsules. There was no evidence that it

was due to

interactions with medication. "

There is some speculation at the end about why this may be, but no real answers.

[Guest guest]

> " All-cause mortality was not reduced by either form of advice, and no other

effects were

> attributable to fruit advice. Risk of cardiac death was higher among subjects

advised to

> take oily & #64257;sh than among those not so advised; the adjusted hazard

ratio was

1.26 (95%

> con & #64257;dence interval 1.00, 1.58; P ¼ 0.047), and even greater for sudden

cardiac

death

> (1.54; 95% CI 1.06, 2.23; P ¼ 0.025). The excess risk was largely located

> among the subgroup given & #64257;sh oil capsules. There was no evidence that

it was

due to

> interactions with medication. "

>

> There is some speculation at the end about why this may be, but no real

answers.

>

>

>

I confess that this is very frustrating. I wish there was more clarity. Do

fish oils prevent

heart attacks & deaths or cause them? If it were merely an academic question, I

would

simply be curious. But with my father's health and possibly even life at stake,

the stakes

are a bit higher.

I'm not sure what to recommend at this point. I come across information like

the JELIS

trial:

" The JELIS Trial, the topic of a previous Heart Scan Blog post, showed that

supplementation

with the single omega-3 fatty acid, EPA, 1800 mg per day (the equivalent of 10

capsules

of 'standard' fish oil that contains 180 mg per day of EPA, 120 mg of DHA)

significantly

reduced heart attack in a Japanese population. Interestingly, this benefit was

additive to

the already substantial intake of omega-3 fatty acids among the general Japanese

population, a population with a fraction of the heart attacks found in western

populations

like the U.S. (approximately 3% over 5 years in Japanese compared to

several-fold higher

in a comparable American group). "

and it makes me think that fish oils may be beneficial for CVD. But of course

we don't

have to look far to find a study that contradicts these results.

I guess the safest course would be to avoid them since the research is not

totally clear.

But nor is it clear on antioxidants and other potential remedies for my father's

condition.

Reducing n-6 PUFA and limiting carbs seems a sure thing, but he's already been

doing

that for several years now.

What would you do in my shoes?

[Guest guest]

> What would you do in my shoes?

If the question is supplements for secondary prevention of heart disease, the

Studer, Briel

et al meta analysis finds statins and omega 3 have statistically significant

reductions in

total mortality. Statins have side effects and shouldn't be the first choice,

even though they

seem to prolong life. So, despite the contradictory evidence from the Burr et al

trial and

serious worries about the n-3 PUFAs lipid peroxidation, for someone who already

has

heart disease, the balance of the clinical trial evidence supports fish oil. The

Agency for

Healthcare Research and Quality survey lists five randomized clinical trials of

fish oil (not

dietary advice to eat more fish), all of which show reductions in mortality. At

some point

you have to go with the clinical evidence.

I would consider krill oil instead of fish oil as a manufacturer-sponsored

study, but done

by academics, showed a much higher effect on lipids for krill oil than fish oil.

Personally, I do not have serious heart disease and discontinued krill oil based

on M's

posts to this list about lipid peroxidation. But the large number of positive

trials for fish

oil put this supplement far above all others for secondary prevention.

So krill oil, cod liver oil, and high-vitamin butter oil would be my supplements

of choice

for someone with heart disease. I would read more about CoQ10 and treat claims

about l-

arnitine very carefully.

[Guest guest]

> I would consider krill oil instead of fish oil as a manufacturer-sponsored

study, but

done

> by academics, showed a much higher effect on lipids for krill oil than fish

oil.

>

> Personally, I do not have serious heart disease and discontinued krill oil

based on Chris

M's

> posts to this list about lipid peroxidation. But the large number of positive

trials for fish

> oil put this supplement far above all others for secondary prevention.

>

> So krill oil, cod liver oil, and high-vitamin butter oil would be my

supplements of choice

> for someone with heart disease. I would read more about CoQ10 and treat claims

about

l-

> arnitine very carefully.

That was my impression about fish oil & secondary prevention, but I haven't done

an

extensive review of the literature. I've seen the krill oil studies and was

taking it myself

before I read Chris's report as well. I think that's what I'll recommend to my

dad, in

addition to CLO/butter oil.

Regarding CoQ10, here are a few abstracts from studies from the article I linked

to and

elsewhere:

Coenzyme Q10 and Cardiovascular Disease: A Review.

Alternative Medicines for Cardiovascular Diseases

Journal of Cardiovascular Nursing. 16(4):9-20, July 2002.

Sarter, Barbara PhD

Abstract:

This article provides a comprehensive review of 30 years of research on the use

of

coenzyme Q10 in prevention and treatment of cardiovascular disease. This

endogenous

antioxidant has potential for use in prevention and treatment of cardiovascular

disease,

particularly hypertension, hyperlipidemia, coronary artery disease, and heart

failure. It

appears that levels of coenzyme Q10 are decreased during therapy with HMG-CoA

reductase inhibitors, gemfibrozil, Adriamycin, and certain beta blockers.

Further clinical

trials are warranted, but because of its low toxicity it may be appropriate to

recommend

coenzyme Q10 to select patients as an adjunct to conventional treatment.

Dietary Cosupplementation With Vitamin E and Coenzyme Q10 Inhibits

Atherosclerosis in

Apolipoprotein E Gene Knockout Mice

Shane R. ; B. Leichtweis; Knut Pettersson; D. Croft; Trevor

A. Mori;

J. Brown; Roland Stocker

From the Biochemistry (S.R.T., S.B.L., R.S.) and Cell Biology (A.J.B.) Groups,

The Heart

Research Institute, Camperdown, NSW, Australia; Cardiovascular Pharmacology

(K.P.),

AstraZeneca R & D, Mölndal, Sweden; and Department of Medicine (K.D.C., T.A.M.),

University of Western Australia, Royal Perth Hospital, Perth, Western Australia.

------------------------------------------------------------------

(Arteriosclerosis, Thrombosis, and Vascular Biology. 2001;21:585.)

© 2001 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Dietary Cosupplementation With Vitamin E and Coenzyme Q10 Inhibits

Atherosclerosis in

Apolipoprotein E Gene Knockout Mice

" CoQ10 significantly inhibited atherosclerosis at aortic root and arch, whereas

VitE

decreased disease at aortic root only. Thus, in apoE-/- mice, VitE+CoQ10

supplements

are more antiatherogenic than CoQ10 or VitE supplements alone and disease

inhibition is

associated with a decrease in aortic lipid hydroperoxides but not

7-ketocholesterol. "

(partial clipping from abstract)

--------------------------------------------

Mol Aspects Med. 1994;15 Suppl:s165-75.Links

Usefulness of coenzyme Q10 in clinical cardiology: a long-term study.

Langsjoen H, Langsjoen P, Langsjoen P, Willis R, Folkers K.

University of Texas Medical Branch, Galveston 77551, USA.

Over an eight year period (1985-1993), we treated 424 patients with various

forms of

cardiovascular disease by adding coenzyme Q10 (CoQ10) to their medical regimens.

Doses

of CoQ10 ranged from 75 to 600 mg/day by mouth (average 242 mg).

(snip)

In conclusion, CoQ10 is a safe and effective adjunctive treatment for a broad

range of

cardiovascular diseases, producing gratifying clinical responses while easing

the medical

and financial burden of multidrug therapy.

--------------------------------------------------------------

I haven't had the chance to read the full studies yet. The second one is the

one referenced

in the article which suggests that vitamin E & CoQ10 work synergistically, as

pointed

out.

[Guest guest]

More on CoQ10:

http://www.lef.org/magazine/mag2000/april00-cover2.html

There are a number of references at the end of the article I intend to get

through when I have

the time.

If you haven't had a chance to read the previous article I linked to, it's worth

a look. Some

good info on the interaction between E & CoQ10, and the role of CoQ10 in

potentially

treating heart disease. The author is a bit sloppy with references,

unfortunately - some are

provided, and some not.

http://www.oralchelation.com/technical/coq101.htm

[Guest guest]

> So krill oil, cod liver oil, and high-vitamin butter oil would be my

supplements of choice

> for someone with heart disease. I would read more about CoQ10 and treat claims

about

l-

> arnitine very carefully.

>

>

>

A new study published in the Journal of the American College of Cardiology

suggested

that " a lifetime of eating tuna, sardines, salmon and other fish appears to

protect

Japanese men against clogged arteries, despite other cardiovascular risk

factors. "

The authors found that intimal-medial thickness (IMT) values were inversely

related to n-

3 levels, even after adjustment for traditional cardiovascular risk factors -

but only in

Japanese men.

No significant inverse association between omega-3 fatty acid levels and

atherosclerosis

was observed in whites or Japanese-Americans once cardiovascular risk factors

were

accounted for.

Japanese men in Japan have equally bad or worse cardiovascular risk profiles as

Americans, but less heart disease? How can this be? " said Dr. , who was

not involved

in the ERA JUMP study. " What really distinguishes the Japanese men from the

Americans is

the fact that blood levels of the omega-3 fatty acids are twice as high in Japan

as they are

in the West.

" The take home message from this important study is this: Traditional risk

factors lead to

traditional amounts of artery-clogging plaque but only when the background diet,

perhaps the lifetime diet, is chronically deficient in omega-3 fatty acids.

Increase the

omega-3 intake and heart disease rates in the West should begin to move closer

to those

in Japan. While it may take a high omega-3 diet from birth (as opposed to

popping a few

fish oil pills) to reach this goal, Dr. Sekikawa and his colleagues tell a

compelling story that

we would do well to heed. "

& : what do you think?

[Guest guest]

This seems sketchy. If omega 3 is related to heart health, why is this

relationship only

found in Japan? Maybe it has to do with development before adulthood, but maybe

it is

just a spurious correlation.

>

>

> > So krill oil, cod liver oil, and high-vitamin butter oil would be my

supplements of

choice

> > for someone with heart disease. I would read more about CoQ10 and treat

claims

about

> l-

> > arnitine very carefully.

> >

> >

> >

>

> A new study published in the Journal of the American College of Cardiology

suggested

> that " a lifetime of eating tuna, sardines, salmon and other fish appears to

protect

> Japanese men against clogged arteries, despite other cardiovascular risk

factors. "

>

> The authors found that intimal-medial thickness (IMT) values were inversely

related to

n-

> 3 levels, even after adjustment for traditional cardiovascular risk factors -

but only in

> Japanese men.

>

> No significant inverse association between omega-3 fatty acid levels and

atherosclerosis

> was observed in whites or Japanese-Americans once cardiovascular risk factors

were

> accounted for.

>

> Japanese men in Japan have equally bad or worse cardiovascular risk profiles

as

> Americans, but less heart disease? How can this be? " said Dr. , who was

not

involved

> in the ERA JUMP study. " What really distinguishes the Japanese men from the

Americans

is

> the fact that blood levels of the omega-3 fatty acids are twice as high in

Japan as they

are

> in the West.

>

> " The take home message from this important study is this: Traditional risk

factors lead

to

> traditional amounts of artery-clogging plaque but only when the background

diet,

> perhaps the lifetime diet, is chronically deficient in omega-3 fatty acids.

Increase the

> omega-3 intake and heart disease rates in the West should begin to move closer

to

those

> in Japan. While it may take a high omega-3 diet from birth (as opposed to

popping a

few

> fish oil pills) to reach this goal, Dr. Sekikawa and his colleagues tell a

compelling story

that

> we would do well to heed. "

>

> & : what do you think?

>

[Guest guest]

,

> This seems sketchy. If omega 3 is related to heart health, why is this

> relationship only

> found in Japan? Maybe it has to do with development before adulthood, but

> maybe it is

> just a spurious correlation.

I think he's saying that there is a threshold level of n-3, above

which n-3 becomes the dominant factor, and below which the traditional

American risk factors become dominant. What is annoying is that this

is pure speculation and he's presenting it as fact. Of course, it's

*possible.*

Chris

[Guest guest]

--- In , " Masterjohn "

<chrismasterjohn@...>

wrote:

>

> ,

>

> > This seems sketchy. If omega 3 is related to heart health, why is this

> > relationship only

> > found in Japan? Maybe it has to do with development before adulthood, but

> > maybe it is

> > just a spurious correlation.

>

> I think he's saying that there is a threshold level of n-3, above

> which n-3 becomes the dominant factor, and below which the traditional

> American risk factors become dominant. What is annoying is that this

> is pure speculation and he's presenting it as fact. Of course, it's

> *possible.*

>

> Chris

>

&

Do you have any other ideas that might explain the results of the study? In

particular, why

is heart disease so much less common among Japanese men in spite of them having

the

same or even greater risk factors as white and Japanese Americans?

I remember reading some interesting work a while back that looked at the

increase in

rates among Japanese American immigrants when compared to Japanese men living in

Japan. The prevailing theory about that was of course that the Japanese

Americans began

following an American diet and that was causing the increase in heart disease.

However, when this researcher (can't remember his name right now) looked more

closely,

he found that heart disease only increased in a certain subsection of the

Japanese

American population. And what he found was that diet was not the distinguishing

factor.

Instead, the group that had fewer heart attacks had retained some or most of

their

traditional Japanese cultural practices, while those that had completely adopted

the

" American way of life " were having more heart attacks. The key factor,

according to this

author, was stress.

It was an interesting study... but it certainly doesn't seem like Japanese men

today are less

stressed than American men. But perhaps there are cultural factors that

mitigate their

stress levels or protect them in some way.

[Guest guest]

thanks for your feedback. I think I'll pass on it for now. After I read the book

The Yoga of

Eating, I decided to only eat foods that tasted good to me. For most of my life,

I've eaten

foods that I thought were healthy even if they tasted awful, and avoided yummy

tasting foods

if I'd read that they were unhealthy. I love butter but avoided it due to the

saturated fats. I ate

flax oil and olive oil instead even though I hated the taste of olive oil. Now,

I've ditched the

flax and olive oils and eat butter to my heart's content. I feel that if my body

doesn't like the

taste of something, maybe it's trying to tell me something.

>

> > how does it taste? I've heard that it can burn the back of your throat. what

has your

> > experience with it been?

>

> It is unpleasant. I take it only because it may be less processed than other

types.

>

>

>

[Guest guest]

> Do you have any other ideas that might explain the results of the study? In

particular, why

> is heart disease so much less common among Japanese men in spite of them

having the

> same or even greater risk factors as white and Japanese Americans?

Speculation at this level is useless. There are thousands of measured and

unmeasured

differences between the US and Japan. Weston Price did much more useful across

group

comparisons of disease. He showed vastly different disease rates between

otherwise very

similar villages, where one village had kept its native food and others had

switched. The key

in this type of analysis is " otherwise very similar. "

[Guest guest]

> Do you have any other ideas that might explain the results of the study? In

> particular, why

> is heart disease so much less common among Japanese men in spite of them

> having the

> same or even greater risk factors as white and Japanese Americans?

I basically agree with . I would have mentioned the study you

mentioned yourself as a possible explanation, but ultimately there are

two major problems:

First, the comparison is illegitimate, because the diagnosing is being

done by different doctors. It has already been shown that even

between more culturally similar countries like US and countries in

western Europe, the rates of diagnosis for heart disease vary widely

even when diagnosing the same bodies. So diagnostic practices could

account for the difference (American doctors diagnose heart disease

most out of everyone).

Second, it's an ecological study, which is the least reliable type of

epidemiological evidence, because it analyzes something that occurs at

the level of an individual at the level of a nation.

Chris

[Guest guest]

--- In , " Masterjohn "

<chrismasterjohn@...>

wrote:

>

>

>

> > Do you have any other ideas that might explain the results of the study? In

> > particular, why

> > is heart disease so much less common among Japanese men in spite of them

> > having the

> > same or even greater risk factors as white and Japanese Americans?

>

> I basically agree with . I would have mentioned the study you

> mentioned yourself as a possible explanation, but ultimately there are

> two major problems:

>

> First, the comparison is illegitimate, because the diagnosing is being

> done by different doctors. It has already been shown that even

> between more culturally similar countries like US and countries in

> western Europe, the rates of diagnosis for heart disease vary widely

> even when diagnosing the same bodies. So diagnostic practices could

> account for the difference (American doctors diagnose heart disease

> most out of everyone).

>

> Second, it's an ecological study, which is the least reliable type of

> epidemiological evidence, because it analyzes something that occurs at

> the level of an individual at the level of a nation.

>

> Chris

>

Thanks for clarifying that, & . Nevertheless, it does seem like

there's still

some benefit in secondary populations as pointed out.

The question is, does my dad qualify as " secondary " ? He hasn't had any

CVD-related

event, but his CMIT scan showed atherosclerotic carotid arteries.

[Guest guest]

Just received Dr. 's " Track Your Plaque " book. It will go right back to

Amazon. He

advocates completely eliminating saturated fat and replacing it with, guess

what,

polyunsaturated fat. At least he points out that omega-6 oils aren't ideal, but

he says they

are " neutral " and can be used for cooking, etc. in moderation. He wants people

to eat a lot

of oily fish and take lots of fish oil.

He admits that cholesterol is not the problem, yet all through his dietary

recommendations

he praises a particular food or approach because it " lowers cholesterol " .

Oh well.