Benefits of fish oil supplementation strongest in patients not on lipid-lowering therapy

SAN DIEGO — While fish oil supplementation appears to have antiatherothrombotic benefits, its effects are more pronounced among patients who are not also on lipid-lowering therapies, according to data presented at the American College of Cardiology Scientific Sessions.

Researchers studied 600 patients with suspected CAD. Of those, 128 reported using fish oil supplements and 472 did not use fish oil supplements, as indicated by levels of omega-3 polyunsaturated fatty acids. Patients’ lipid profiles were obtained and thrombogenicity was measured via light transmittance aggregometry, thromboelastography and urinary levels of 11-dehydrothromboxane B2 prior to coronary angiography.

Paul A. Gurbel

Across the entire study population, researchers observed associations between fish oil supplementation and lower triglycerides (P = .04), total very–low-density lipoprotein (P = .002), intermediate-density lipoprotein (P = .02) and AtherOx (P = .02), a molecule that is a combination of oxidized LDL and beta-2 glycoprotein 1 and is believed to be a marker of inflammation and pro-thrombosis, Paul A. Gurbel, MD, director of the Sinai Center for Thrombosis Research at Sinai Hospital in Baltimore, told Cardiology Today.

However, these associations were observed only among patients who were not also receiving lipid-lowering therapy. The researchers reported no significant influence from reported fish oil use on the lipid profiles of patients already taking a statin.

Among patients not taking lipid-lowering therapy, Gurbel and colleagues observed significantly lower total very–low-density lipoprotein (P = .0005), intermediate-density lipoprotein (P = .003), triglycerides (P = .009) and AtherOx levels (P = .005) with fish oil use compared with nonuse.

Urinary levels of 11-dehydrothromboxane B2 were lower with fish oil supplement use compared with nonuse across the total population (P = .0007). This difference remained significant among patients on lipid-lowering therapies (P = .04) and those not on lipid-lowering therapies (P = .004).

Evaluation of the influence of fish oil supplement use on platelet aggregation indicated no significant difference in response to collagen or ADP among users vs. nonusers. In an analysis of thrombogenicity, clot strength was significantly reduced with fish oil use, but only among patients who were not on lipid-lowering therapies.

“Fish oil may have its most potent antiatherothrombotic effects in patients not on lipid-lowering therapy,” said Gurbel, a member of the Cardiology Today’s Intervention Editorial Board. “However, there are anti-inflammatory effects whether or not a patient is on a statin, as shown by the measurement of these markers.”

Gurbel noted that the clinical application of these findings should be assessed in a larger-scale clinical trial. “We need to look at these markers, look at the response to fish oil and see how that correlates with clinical outcomes,” he said. – by Adam Taliercio

Reference:

Gurbel PA, et al. Abstract 1115-361. Presented at: American College of Cardiology Scientific Sessions; March 14-16, 2015; San Diego.

Disclosure: The Sinai Center for Thrombosis Research supported the study. Gurbel reports receiving consultant fees and/or honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Lilly and Merck, as well as research grants from Accriva, AstraZeneca, Coramed, CSL, Daiichi Sankyo, Duke Clinical Research Institute, Haemonetics, Harvard Clinical Research Institute, the NIH and Sinnowa.