Apr 2, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Why does your phone say two thousand something dollars on it?" I wasn't too worried. I assumed Eric was playing a game. Maybe he was a virtual hit man and had just earned a commission for some blood soaked task. Or maybe something else just as life affirming. But I was a little concerned my credit card might suddenly have a huge charge on it. "It doesn't say $2000, Dad. It says 2 million." Okay, what was going on? "Well I own 33% of Coop. My friend Owen owns 20% of the hospital, but I don't think that was a good investment. His expenses are higher than his rental income. The hospital is a money loser." Something was very fishy. This is a boy who I usually hear scream things like "Shoot him again! Shoot him again! I think we lost the hostage."

A very specific component of fish oil called an omega 3 fatty acid was involved in heart disease study called REDUCE-IT. In fact, it was a very specific type of omega 3 fatty acid called EPA or eicosapentaenoic acid that was in the study. Well, actually it was even more specific. REDUCE-IT used a highly purified EPA ethyl ester called icosapent ethyl. Icosapent ethyl is marketed under the brand name Vascepa.

Let's back up and talk about cholesterol and the heart. Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. Cholesterol helps form bile acids in your digestive system, hormones in your endocrine system and important components of every cell membrane in your body. Your liver can make all the cholesterol your body needs. The cholesterol in the food you eat doesn't go directly into your blood stream. Your liver makes cholesterol for you. We care about blood cholesterol levels because if they are too high for too long you have higher chance of getting a heart attack or a stroke. Every 7 minutes in Canada, someone dies of cardiovascular disease. That is why we care about blood cholesterol levels. And that is why cholesterol medications are so common.

Before we get back to fish oils and heart disease, we must quickly mention statins. Statins are the most popular cholesterol medications because they have by far the most and best evidence for reducing heart attacks, strokes and death. Even the REDUCE-IT trial was done with people who were already on a statin. The omega-3 fatty acid was an add on to the statin. So, although certain omega-3 fatty acids might be very good for your heart, they certainly do not replace statins.

The REDUCE-IT trial by Deepak Bhatt et al. was published in the New England Journal of Medicine in January 2019. REDUCE-IT stands for Reduction of Cardiovascular Events with Icosapent Ethyl Intervention Trial. The researchers signed up 8179 people with established heart disease or diabetes with at least one extra heart disease risk factor. Half were given the special omega-3 fatty acid called icosapent ethyl and half were given mineral oil. They were all already on a statin. Even though they were on a statin, one of their blood lipid numbers, their triglycerides, were still high. After about 5 years, 4.9 % fewer of the people getting the icosapent ethyl had a heart event. Heart events were cardiovascular death, nonfatal heart attack, nonfatal stroke, getting a by-pass operation or unstable angina. That means you'd need to treat about 21 people with icosapent ethyl for 5 years to prevent one heart event.

Like all studies, REDUCE-IT wasn't perfect. It showed a higher incidence of a less serious heart condition called atrial fibrillation in the icosapent ethyl group. There is some possibility that the mineral oil used in the placebo group might have interfered with the absorption of the statin in the placebo arm. So, it is possible the people in the placebo arm just got less statin drug.

These are still good news numbers, though. I think doctors will start putting more people on icosapent ethyl in addition to their statins. Unfortunately, right now, icosapent ethyl, marketed under the brand name Vascepa, it isn't available in Canada yet.

How about taking an omega-3 fatty acid supplement to protect your heart? Will that help? Maybe. The Canadian Cardiovascular Society does not recommend taking an omega-3 supplement just to protect your heart. A large study called ASCEND with 15,480 people found no difference in heart problems between people who took an omega-3 supplement versus a placebo over about 8 years. Another large trial called VITAL with 25,871 people also found no real difference in total heart problems between omega-3 and placebo over about 5 years. VITAL did seem to indicate that people on omega-3 fatty acid supplements might get fewer heart attacks.

If taking omega-3 fatty acid supplements is marginally better than a placebo at preventing heart problems and Vacepa isn't on the market in Canada yet, what should you do? Eat fish. The American Heart Association recommends adults eat a 3.5 ounce serving of cooked or ¾ cup flaked fatty fish like tuna or salmon twice a week.

Eric and his friends have started playing the video game "Landlord Real Estate Tycoon". It seems to be a combination of Pokémon Go and Monopoly. Although they don't seem to have to leave the house, Eric and his friends are buying up local Dauphin buildings and businesses. Apparently, Eric's virtual Real Estate Empire is now worth over 2 million dollars. I wonder how he'd do in the stock market if I told him it was a game? Do I have an investing prodigy in the house? Or does that just sound fishy?

As always if you have any questions or concerns about these products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at

NEJM - REDUCE-IT trial -

American Heart Association- Omega-3 fatty acids -


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