Does fish oil ADD to statin therapy?

Yet another patient came to my office today saying, "My primary doctor said that I should stop taking fish oil. He say's that I don't need it because I take Crestor."

The woman was in tears, confused and frightened over a potential disagreement between her doctors.

Is this true? If someone takes a statin drug, like Crestor, Lipitor, Zocor (simvastatin), pravachol, or lovastatin, they don't need to take anything else because the statin drug is so powerful that it eliminates risk?

No. Not even close to the truth.

First of all, let's accept that virtually the entire body of statin drug literature--hundreds of studies, billions of dollars spent--was paid for by the drug industry. It's no news that studies paid for by the sponsor are likely to favor the sponsor. Imagine Ford sponsored a study of Ford vs. GM cars vs. Toyota, paying $10 million to fund the effort. Guess who is likely to come out on top? "Studies show that Ford makes the best car in America." (Sorry, I don't mean to pick specifically on Ford. It's just a widely-recognized brand.)

So that means that the statin literature likely overestimates the benefit of statin drugs. Even so, it's clear from the hundreds of studies performed that the best we can hope for by taking statin drugs is a reduction of heart attack and death from heart attack of 30-35%--best case. That doesn't sound like elimination of risk to me.

What are the incremental benefits of adding omega-3 fatty acids from fish oil added to statins? The best data originate with the JELIS Trial (Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis), in which 19,000 Japanese participants (who already have a high omega-3 intake from diet, usually ranging from 1800-3000 mg per day) experienced a 19% reduction (relative reduction) in cardiovascular events.

GISSI Prevenzione demonstrated a 28% reduction in heart attack, 45% reduction in death from heart attack with fish oil.

Omega-3 fatty acids from fish oil also:

--Reduce triglycerides dramatically
--Accelerate after-eating clearance of digestive by-products, i.e., they correct post-prandial abnormalities
--Modify the character (fragmentation potential, structural strength) of plaque
--Raise HDL modestly

If you buy your fish oil from Sam's Club, Costco, or other discounter, a healthy dose of fish oil might cost you $3 per month. Compare that to the $120 per month average cost of a statin agent. Why is there even a discussion over this?

Sadly, the doctor on Main Street, U.S.A, is the unwitting puppet of the pharmaceutical industry. The pretty drug company representative with nice legs and a cute smile promises lunch, dinner and . . who knows what else? Wink. The fifty-something, hairline-receding doctor can't resist. "Of course I'll prescribe your drug!"

Don't kid yourself: The drug industry knows precisely how to manipulate the behaviors of the deliverers of their products.

So, do statin drugs make omega-3 fatty acids from fish oil irrelevant? Absolutely not.

It's all about trying to inch closer and closer--not to reduction--but to elimination of risk for heart disease.

Comments (9) -

  • Steve

    10/18/2008 3:23:00 PM |

    Dr. Davis:
    doctors including most in your specialty use statins as their first line of defense in treating heart disease. Perhaps because it is easy; perhaps because of the drug company sponsored tests.  In any event, it may be that it makes sense in some cases, only we the public do not know when they should be prescribed.  Perhaps you can enlighten us on when and for what reasons you would prescribe statins, if at all.
    Excellent post.

  • Anonymous

    10/19/2008 2:47:00 AM |

    Why didn't you tell her that it's now been proven that no woman should ever be on statins (and very few men should be.)

    My mom now has to walk with a cane after six months on statins, at her idiot doctor's insistence.

    At least I'm sure her doc enjoyed his free lunches (paid for by hot, nubile drug reps, just a year or two out of the sorority.)

    Sometimes this country makes me want to VOMIT!

  • Zbigniew

    10/19/2008 8:01:00 AM |

    Dr. Eades keeps repeating it's never been proven that statins do any good to women of any age - what do you think about it, maybe that patient should just stop taking statins and increase fish oil?

  • TedHutchinson

    10/21/2008 4:27:00 PM |

    http://www.lipidworld.com/content/pdf/1476-511x-7-37.pdf
    In this paper Das proposes that a rational combination of -3 and -6 fatty acids and the co-factors that are necessary for their appropriate action/metabolism is as beneficial as that of the combined use of a statin, thiazide,a  blocker, and an angiotensin converting enzyme (ACE) inhibitor, folic acid, and aspirin.
    Furthermore, appropriate  combination of -3 and -6 fatty acids may even show additional
    benefits in the form of protection from depression, schizophrenia, Alzheimer’s disease, and enhances cognitive function; and serve as endogenous anti-inflammatory molecules; and could be administered from childhood for life long.

    But I suspect that such an approach would not be as profitable as the use of a polypill.

  • Gabrielle

    10/24/2008 10:29:00 AM |

    RCT's have demonstrated that Omega 3 fatty acid supplements can reduce
    cardiac events like death,non fatal MI and non fatal stroke.

    I like Omega3 fatty acid supplement from Neurovi.It has many benefits related with Heart disease.Check out the website of Neurovi.

    www.neurovi.com

  • Anonymous

    10/26/2008 6:19:00 AM |

    There's a relatively new (rat) study on krill oil.

    If you're interested, you can access the abstract here:

    http://www.ncbi.nlm.nih.gov/pubmed/18755044?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

  • buy jeans

    11/3/2010 10:30:02 PM |

    Is this true? If someone takes a statin drug, like Crestor, Lipitor, Zocor (simvastatin), pravachol, or lovastatin, they don't need to take anything else because the statin drug is so powerful that it eliminates risk?

  • simvastatin side effects

    5/7/2011 11:26:23 AM |

    We must first gather some informations bbelieving that when we take statin, we should not take any other like fish oil.

  • simvastatin side effects

    5/7/2011 11:27:12 AM |

    We must first gather some informations before believing that when we take statin, we should not take any other like fish oil.

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