One Fish, Two Fish, Red Fish, Cardiovascular Benefits Fish

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We've had a lot of heart stopping moments in the past week thanks to the SCOTUS fun, so let's chat about something GOOD for your heart! I am a huge skeptic of vitamins and supplements, but they make billions of dollars a year from consumers wanting to do healthy things for their bodies. At best, there is no evidence to show that they improve anything, other than maybe your peace of mind that taking some fish oil tablets will counteract those Krispy Kremes you feel guilty about. Well, nopety nope. A study back in 2013 showed zero benefit from taking n-3 fatty acid supplements (think fish oil) versus placebo. It was a big study with over 12,000 subjects enrolled and published in the New England Journal of Medicine . The investigators compared rates of death, heart attacks and strokes in the two groups and found zero difference. Zilch. Nada, amigos. There are plenty of other studies also showing no benefits. But all that changed a week ago with Amarin's Vascepa phase III study.

More on that in a minute, but first a quick reminder of the kinds of lipids (fats) inside of you and why the levels in your blood matter.

Common wisdom tells us that there are three main types of lipids: triglycerides, steroids, and phospholipids. There are other ways to classify them and some other types (some antibiotics, for example), but this will suffice for us today and the healthy heart talk. Let's hit each one in reverse order.

Phospholipids

"Phospo" for the phosphorous atom present in each molecule and what makes it the coolest fat around. Lipids, for, um, duh, the lipid part of the molecule. Why are these fat molecules the coolest? Glad you asked! The phosphorus "head" of the molecule gives it some charge, which is distinct from the fatty "tail." Because of that structure, in water, the molecules will self-organize into structures called liposomes. In your body, they are what form the membranes of your cells. Without our little microscopic sperm-like friends you couldn't have cells and therefore couldn't have life. Here is a diagram of the tiny guys and how they like to line up in water and to make your cell membranes:

Steroids

You see steroid and think of this:

Ah, but that's just one side of the category. Hormones like testosterone are steroids, but so are the cholesterols. Cholesterol gets a bad rap, but that's because too much of it, mixed with some other molecules, causes plaque to build up in your arteries and well, you know why THAT'S bad. Still, our little amigo is important for cell repair and creating new cells. So, we know that lowering high levels of cholesterol, or LDL specifically, is a good thing for you. That's where the statins came and have increased life spans for millions of people. But what about…

Triglycerides

This is the one where a doctor says, "Looks like your LDL is through the roof, your HDL is too low to do much good and your triglycerides REALLY need to come down, Mr. President." These fats are important for energy storage. Sugars and starches are great for quick energy, but triglycerides are more efficient molecules for storing energy you might need if you stay up late Tweeting about all the wisdom you saw earlier in the day on Fox News. You NEED triglycerides, but you don't want too many because they'll clog up the heart pipes and increase your chances for heart attacks, strokes and death. Also, you won't look too good on the golf course in your white polo shirt.

This brings us back to fish oil, and more specifically omega 3 fatty acids which some kinds of fish (salmon, etc.) are chock full of. One more thing that will become important at the end of this paragraph is that there are two main types of fatty acids in fish oil, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Like I said, all the studies on fish oil supplements have been negative for any kind of heart benefit. That changed last week! Vascepa is a drug that's already been approved to lower triglycerides in patients with very high levels. What they showed in the new study, though, is that the drug can actually lower the rate of death, heart attacks and strokes versus a placebo. Why did this drug work where other drugs and supplements based on fish oil extracts failed? All the failed ones to date have been a mix of fatty acids. Vascepa is made from only EPA. That is likely the differentiating factor, but we can't know for sure as the dose tested was also much higher than other competitive drugs and supplements have tried. Still, you can't argue with the highly statistically significant 25% decrease in cardiovascular events seen in the study. Whatever the specific reason, that's a solid effect and one that most stock analysts did NOT anticipate. After the announcement, Amarin stock skyrocketed higher than a Presidential LDL level after three 2 AM Big Macs.

Here's a pdf of the REDUCE-IT (cute name, right?) study design and here's a link to the high level results. The details will be presented November 10 at the American Heart Association meeting in Chicago. Stay tuned for now…and go eat some salmon, bitches!

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