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Are prescription fish-oil pills for heart disease for you? What you need to know

One of the prescription fish-oil pills, Vascepa.

One of the prescription fish-oil pills, Vascepa. | Amarin Corp.

Prescription fish-oil pills have now been shown to have a possible heart benefit, as study results presented last weekend in Chicago at the American Heart Association’s annual scientific conference showed.

But how can you know whether this is something for you?

In one trial, heart patients already on a statin, like Lipitor or Zocor, took four grams a day of Vascepa — concentrated EPA, an omega-3 fatty acid from fish oil. The study found a 25 percent risk reduction in cardiac events.

The other study involved a lower dose — one gram — of two omega-3s, an EPA-DHA combo sold as Lovaza or Omacor. It was taken by people with no past heart problems. The study found fewer heart attacks among those taking the fish-oil pill — “a substantial benefit,” according to the study’s leader, though other experts questioned how the study was done.

To help understand the findings and who could benefit, we spoke with three Chicago heart specialists: Dr. Mark Huffman, a cardiologist at the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital, Dr. Khaled Dajani, an associate professor of cardiology at Loyola University Medical Center in Maywood, and Dr. Michael Davidson, the University of Chicago Medicine’s director of preventive cardiology.

Question: Are these available?

Answer: Yes. The federal Food and Drug Administration already has approved them for some patients, though it’s expected that they might become more widely prescribed now, with the study results appearing, with some caveats, positive.

Q: What’s the cost?

A: About $280 a month. Many insurance plans cover them. More now might.

Q: How can you find out whether either drug would be appropriate for you?

Huffman: “Always start by talking with your doctor.

“The [Lovaza] trial really included different patient populations. [The Vascepa trial was] largely people who had a prior cardiovascular event. So these are people who had a heart attack before. People that have had this previous cardiovascular are inherently at a higher risk for developing a subsequent cardiovascular event.

“The second important difference is that these two interventions, while seemingly very similar fish oil, were actually pretty different. I think it’s these differences that seem to be of an important potential driver of the results. We’re still trying to unpack the data in all its detail.”

Q: Is a doctor likely to prescribe this for someone who doesn’t have high triglycerides but has other high risks for cardiovascular disease?

Huffman: “I had a discussion with one of my patients this morning — who did not have a particularly elevated triglyceride level — about the potential role for Vescepa for him.

“The patient hasn’t had a recurring myocardial infarction, or heart attack, in more than 20 years. So he’s declared himself to be somewhat different than the patients in this trial.

“For this patient, both he and I thought that he wouldn’t be an ideal candidate. Even for patients that fit the exact inclusion criteria — like any intervention that we provide in the office for our patients — we have a conversation about risks, benefits and alternatives.

Q: Could I just take more of the fish-oil supplements you can buy without a prescription at a drugstore?

Davidson: “I would definitely not do that because the 20 capsules a day not only gives you a comparable amount but also other stuff you don’t want — like unnecessary calories, other oils that are not protective and maybe other things that are in the supplements that don’t have the same rigor when it comes prescription products. I would caution against trying to match the amount of omega-3s with dietary supplements.”

Q: Can you go to your own doctor about this?

Davidson: “It’s a discussion to have with their primary care doctor. And maybe a specialist may have more details about it. Certainly, it’s something they could talk about it with their doctor and see where it goes from there.”

Q: Are these drugs something that you would recommend for someone in your own family?

Davidson: “I would recommend it now. I’ve been an omega-3 researcher for over 30 years. So I believe in the hypothesis that high doses of omega-3s can make a difference for heart disease. I’m in the camp that are enthusiastic for this approach.”

Dajani: “I think that we need to see more research done. This was one study. I think this is a good study. But I would wait for other studies before widespread use.”

Q: What happens if a patient stops using the drugs?

Davidson: “Once you stop the drug, the benefits stop, too. There may be some legacy benefits, but that’s not yet clear. It should be considered a lifetime therapy.”