Fish oil supplements are fantastic for heart disease!

Fish oil supplements are fantastic for heart disease!

Recent publications have suggested that fish oil supplements in low doses make little difference to heart disease, and people have been advised not to take them. Note I discussed this in my blog three sections down.

However, this has been turned upside down in a recent huge study called the REDUCE-IT trial used 4 g of fish oils daily, in a double-blind randomised trial involving 8179 patients followed over 4.9 years. The results were incredible. All cardiovascular events (death, non-fatal heart attack, non-fatal stroke, need for angioplasty or bypass surgery or unstable angina with all reduced over 25%.
This result is incredible and better than anything claimed by the statin drugs.
It obviously shows that omega-3 fish oils are extremely effective in people at risk of heart disease, but you need to take enough, and it does need to be a quality product.
A smaller study performed in Japan (JELIS trial) using a slightly lower dose of 1.8 g daily achieved in 19% benefit.

So fish oils are very beneficial to people at risk who want to avoid heart disease, or who already have it., But you need to take enough, and I would personally recommend 2 g twice a day of a quality product. There are no significant side-effects, and we have no medicines that can compete with these results.

Should we be taking aspirin

Should we be taking aspirin?

Even though doctors have been recommending patients to take aspirin for many decades, there is still considerable uncertainty on whether we should be making this recommendation, and if so to whom, and what dose?

A recent study suggested that perhaps when people were larger they needed more aspirin, rather than the conventional dose of 100 mg. Two large papers coming from Europe (one involving more than 15,000, and the other more than 12 a half thousand people) have fortunately clarified the situation and confirmed that 100 mg is fine. (More greatly increases the risk of stomach bleeding, with little or no benefit). Large and small people should all take the same dose (100mg).

Primary prevention – people with no evidence of heart disease, we don't have enough evidence to suggest that this is beneficial, and the risk of stomach bleeding is far greater than any possible benefit. Sadly the studies do not confirm that aspirin has any benefit in preventing cancer. Conclusion - don't take aspirin as a preventative.

Those at higher risk – i.e. people with diabetes or family history, again we don't have enough evidence to suggest that this is necessary or beneficial.

People with established heart disease – the data suggests that taking aspirin does reduce the risk of further heart events by about 12%, and I don't think is any doubt that unless there is some contraindication, people who have angina or a heart attack, had angioplasty or bypass surgery should be taking 100 mg of aspirin.  There is a slight increase in the risk of bleeding (usually from the stomach of between 0.5 and 0.9%)

What to do when you have a heart attack

What to do when you have a heart attack

What happens:
One in three of us will die of heart disease, and although becoming slightly less common, a heart attack remains the major cause of death.With a heart attack a fat laden plaque in a coronary artery ruptures, causing a clot which blocks the artery. This can lead to a number of consequences:
1. Chest pain – a tight heavy feeling in the chest, throat, left or right arm,

2. Breathlessness, sweating, faintness and a feeling of being generally unwell frequently happen.
3. The heart can sometimes beat irregularly, causing palpitations, sometimes it can stop or beat in an uncoordinated fashion (ventricular fibrillation), leading to sudden death.

Speed is of the essence - both to reduce the amount of heart damage long term, and also reduce the risk of sudden death.   In the cardiology literature - "minutes mean muscle', ie the longer the delay, the more heart damage occurs. 
If we can dissolve the clot in the artery rapidly (less than 30 minutes) no damage is done at all. However there is benefit up to 6 hours, some believed 12 hours. However at any stage a cardiac arrest can occur, which is why the patient needs to be in a cardiac unit or close to a defibrillator as fast as possible.

While doctors can do –
1. Dissolve the clot with drugs given intravenously (thrombolysis). 

2. Remove the clot and open up the arteries in the cardiac catheter lab – angioplasty and stenting.
3. If the heart goes into fibrillation, this can easily be reversed with a defibrillator. These are routinely present in ambulances, places where people congregate (sports stadium, airports, shopping malls) and of course cardiac units.

What you can do –
1. Get to a cardiac unit (or ambulance) as soon as possible.

Call the ambulance using the emergency number (111, 999, 911) and say you have chest pain.
2. Sit down quietly and relax, if you feel faint lie down flat.
3. Chew one aspirin tablet (300 mg) slosh it round the mouth and then swallow it. This prevents the clot in the artery getting bigger.
4. If you have one, use your Nitrolingual spray one or two puffs every five minutes.
5. If you have some available, take some chewable magnesium or liquid magnesium (500 – 1000 mg), and 1000 mg of omega-3 fish oil. Both of these can  reduce the risk of cardiac arrest.

8 year survival curves, shortest delay (top) to slowest (bottom)

A recent study from the Netherlands has shown that in 3000 patients with a heart attack, the 30 day mortality was 2.6% in those with the shortest delay in reaching hospital catheter lab (mean 72 minutes), compared to 7.4% in those with the longer delay (160 minutes).   Five year mortality was also reduced from 22.6% in those with the longer delay to 12.8% in the shortest delay. 

So - getting to hospital as fast as possible saves lives in both the short and longer term.  DO NOT DELAY, don't worry about a false alarm or being a nuisance, any chest pain lasting more than 10 minutes, call an ambulance!