What To Do After Your 1st Heart Attack . . .

Try as we might to take care of our health, we're bound to run into a few unexpected hiccups along the way, just hopefully, not to frequent nor major.  A heart attack, known medically as a myocardial infarction, is just one of those road bumps.  Using the glass is half full paradigm, I suppose it's better to be able to do something after the fact than have death manifest as the first sign of heart disease. Along those lines, we've known for a while now that in terms of secondary & tertiary prevention (after disease manifestation), the ABCs are imperative: Aspirin, Blood pressure & Cholesterol control.  So I thought it timely that in this month's issue of the European Heart Journal, I found two studies looking at what to do after one's first heart attack.

Fish oil has generally been thought to be beneficial in heart disease, at least observationally, but randomized controlled trial data has been more difficult to find.  In the Alpha Omega Trial, the authors found 4,153 participants (three fourths men, avg age late 60s early 70s, all overweight w/BMI 27) who'd already had their first heart attack.  Most (3,740) were consistent statin users while a minority (413) were consistent non-users (for whatever reason).  All the participants were then randomized to either 400mg of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA), 2g of alpha linolenic acid (another omega 3 fatty acid), or both, and followed for 3 1/2 years.

The outcome was quite interesting.  In those who consistently took their statin, the addition of omega 3 fatty acids, whether fish oil or ALA or both, made no difference in the recurrence of cardiovascular events.  But in those who consistently did not or could not take statins, only the combination of EPA, DHA & ALA was able to impact recurrence rates, dropping relative risk by almost 50% from an absolute rate of 18% down to 9%.  The fly in the ointment?  Statistically speaking, the P-value fell just short of significance at 0.051 as the confidence interval crossed over at 1.01.  For now, in my post-MI patients who can't tolerate a statin, I think that I will still recommend fish oil plus plant-derived ALA.

Stay tuned for the second study on heart attack survivors . . .

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