Big studies give mixed news on fish oil, vitamin D

CHICAGO — Taking fish oil or vitamin D? Big studies give long-awaited answers on who does and does not benefit from these popular nutrients.

Fish oil taken by healthy people, at a dose found in many supplements, showed no clear ability to lower heart or risks. Same for vitamin D.

But higher amounts of a purified, prescription fish oil slashed heart problems and heart-related deaths among people with high triglycerides, a type of fat in the blood, and other risks for heart disease. Doctors cheered the results and said they could suggest a new treatment option for hundreds of thousands of patients like these.

Up to 10 percent of U.S. adults take fish oil . Even more take vitamin D , despite no major studies to support the many health claims made for it.

“Those who peddle it promote it as good for everything,” but in this definitive test, vitamin D “showed a big nothing,” said Dr. James Stein, a heart specialist at the University of Wisconsin-Madison. He had no role in the studies or ties to the companies involved.

Results were revealed Saturday at an American Heart Association conference in Chicago and published by the New England Journal of Medicine.

ABOUT FISH OIL

These oils, also called omega-3 fatty acids, are found in salmon, tuna and certain other fish. They reduce triglycerides and inflammation and may have other effects . There are different types, including EPA and DHA.

One study tested 4 grams a day of Amarin Corp.’s prescription Vascepa, which is concentrated EPA, in more than 8,000 patients with high triglycerides and a greater risk of heart problems for various reasons. All were already taking a statin such as Lipitor or Zocor to lower cholesterol. Half were given Vascepa and the rest, mineral oil capsules as a comparison.

After five years, about 17 percent of those on Vascepa had suffered one of these problems — a heart attack, stroke, heart-related death or clogged arteries requiring medical care — versus 22 percent of the others.

That worked out to a 25 percent reduction in risk. Looked at individually, heart attacks, heart-related deaths and strokes all were lower with Vascepa. Only 21 people would need to take Vascepa for five years to prevent one of the main problems studied — favorable odds, Stein said.

Side effects may be a concern: More people on Vascepa were hospitalized for an irregular heartbeat — 3 percent versus 2 percent of the comparison group. Doctors say that’s puzzling because other research suggests fish oil lowers that risk.

The concern with the heart rhythm problem is that it can raise the risk of stroke, but there were fewer strokes among those on Vascepa, said study leader Dr. Deepak Bhatt of Brigham and Women’s Hospital in Boston.

Vascepa costs around $280 a month; many insurers cover it. Amarin sponsored the study and some study leaders work or consult for the company.

A BROADER TEST

The other study tested a lower 1 gram daily dose of a different type of fish oil — an EPA/DHA combo sold as Lovaza or Omacor and in generic form — in 26,000 people with no prior heart problems or .

After about five years, rates of a combined measure of heart attacks, strokes and other problems were similar for fish oil users and a comparison group. rates and deaths also were similar.

There were fewer heart attacks in the fish oil group — 145 versus 200 in the comparison group. The study leader, Dr. JoAnn Manson at Brigham and Women’s, called that “a substantial benefit,” but several independent experts disagreed because of the way the study was set up to track this and certain other results.

“These findings are speculative and would need to be confirmed in a separate trial,” said the Cleveland Clinic’s Dr. Steven Nissen.

FISHY COMPARISONS?

Both studies share a problem: the oils used for the comparison groups, which may not have been true placebos. The Vascepa study used mineral oil, which interferes with statin drugs, raises cholesterol, and might have made the comparison group fare worse and made Vascepa look better than it truly was.

The other study used olive oil, which might have helped that comparison group do better, possibly masking any benefit to the others from fish oil.

Leaders of both studies say any effect from the comparison oils isn’t enough to alter the main results, and independent experts agreed. But Nissen, who is leading another fish oil study, is using corn oil as a comparison.

THE ‘SUNSHINE’ VITAMIN

Manson’s study also tested vitamin D, which the skin makes from sun exposure. It’s tough to get enough from foods like milk, eggs and oily fish, though many foods now are fortified with it. Some studies have found that people with lower levels of D are more likely to develop , but it’s not known if supplements alter that risk.

Study participants took 2,000 international units of D-3 (the most active form of vitamin D, also called cholecalciferol) or fake vitamin pills for five years.

Vitamin D did not affect the odds of having a heart attack or stroke or developing . After excluding the first two years of use, researchers saw fewer deaths among those on the vitamin — 112 versus 149 in the placebo group.

” can take years to develop” so a difference may not show up right away, Manson said. “This looks promising” and people will be studied longer to see if the trend holds up, she said.

Several other experts said these numbers just hint at a possible benefit that needs more study.

“These ‘positive’ results need to be interpreted with caution,” Dr. Clifford Rosen of Maine Medical Center Research Institute and Dr. John Keaney Jr. of the University of Massachusetts wrote in a commentary in the medical journal.

More US adults and kids are doing yoga, meditating

NEW YORK — If you can do a downward-facing dog, you’re among the increasing numbers of Americans doing yoga.

A new report says more adults — and even kids — are practicing yoga and meditation.

A government survey conducted last year found 14 percent of adults said they had recently done yoga, and the same percentage had recently meditated. That’s up from about 10 percent and 4 percent from a similar survey done five years earlier.

For kids ages 4 through 17, about 8 percent had recently done yoga, up from 3 percent. For meditation, it was about 6 percent, similar to the earlier survey.

Experts say yoga, meditation and some other forms of complementary medicine have been increasingly promoted as ways to reduce stress and anxiety and improve health.

New exercise guidelines: Move more, sit less, start younger

CHICAGO — Move more, sit less and get kids active as young as age 3, say new federal guidelines that stress that any amount and any type of exercise helps health.

The advice is the first update since the government’s physical activity guidelines came out a decade ago. Since then, the list of benefits of exercise has grown, and there’s more evidence to back things that were of unknown value before, such as short, high-intense workouts and taking the stairs instead of an elevator.

“Doing something is better than doing nothing, and doing more is better than doing something,” said Dr. Donald Lloyd-Jones, a preventive medicine expert at Northwestern University in Chicago.

Only 20 percent of Americans get enough exercise now, and the childhood obesity problem has prompted the push to aim younger to prevent poor health later in life.

Highlights of the advice released Monday at an American Heart Association conference in Chicago and published in the Journal of the American Medical Association:

CHILDREN AND TEENS

The biggest change: Start young. Guidelines used to begin at age 6, but the new ones say preschoolers ages 3 through 5 should be encouraged to take part in active play throughout the day. They don’t call for a certain amount but say a reasonable target may be three hours of various intensities. That’s consistent with guidelines in many other countries and is the average amount of activity observed in kids this age.

From ages 6 through 17, at least an hour of moderate-to-vigorous activity throughout the day is recommended. Most of it should be aerobic, the kind that gets the heart rate up such as brisk walking, biking or running. At least three times a week, exercise should be vigorous and include muscle- and bone-strengthening activities like climbing on playground equipment or playing sports.

ADULTS

Duration stays the same — at least 2½ to 5 hours of moderate-intensity or 1 ¼ to 2 ½ hours of vigorous activity a week, plus at least two days that include muscle-strengthening exercise like pushups or lifting weights.

One key change: It used to be thought that aerobic activity had to be done for at least 10 minutes. Now even short times are known to help. Even a single episode of activity gives short-term benefits such as lowering blood pressure, reducing anxiety and improving sleep.

Sitting a lot is especially harmful.

The advice is similar for older adults, but activities should include things that promote balance to help avoid falls.

BROUGHT TO YOU BY THE LETTER E

Targeting young children is the goal of a project that Dr. Valentin Fuster, a cardiologist at New York’s Mount Sinai Hospital, has worked on for years with the Heart Association and Sesame Workshop, producers of television’s “Sesame Street.”

At the heart conference, he gave results of an intensive four-month program to improve knowledge and attitudes about exercise and health among 562 kids ages 3 to 5 in Head Start preschools in Harlem.

“It was really successful,” Fuster said. “Once they understand how the body works, they begin to understand physical activity” and its importance.

When brains are young, “it’s the best opportunity” to set health habits that last, he said.