Reducing risk for high-risk heart patients

Managing the high-risk patient has remained a challenge to most physicians. The good news is that there are now available medicines and supplements which have been proven to significantly reduce their risk of developing heart attack, stroke and even sudden death.

Health experts advise that a healthy lifestyle consisting of a diet and moderate exercise remains the mainstay of treatment. Drugs such as the simple aspirin, cholesterol-lowering drugs belonging to the statin family, drugs which block the renin-angiotensin system (RAS) such as the angiotensin receptor blockers and angiotensin converting enzyme inhibitors are also frequently prescribed.

Over-the-counter food supplements such as omega-3 fish oil has also been recommended by the American Heart Association and other international heart experts in the prevention of heart attacks and strokes in high-risk patients with cardiovascular disease or CVD, particularly in those who already had a previous heart attack.

Rey D., a 67-year-old former government employee, who survived a heart attack before his retirement five years ago, never thought that his occasional attacks of palpitations were already a warning that he was a high-risk candidate for sudden death.

On consultation with his doctor, his heart rhythm was noted to be irregular. “Your heart could just go into a sudden standstill,” his doctor told him. He was fortunate though that his condition was discovered early. He was advised on lifestyle changes he had to make, and given medications to control his irregular heartbeat. Among his medicines were softgel capsules of an omega-3 supplement (Omegabloc) which he was told can help reduce his heart irritability.

Omega-3 has been shown to help reduce the risk of sudden death in patients following a heart attack by as much as 45 percent. This is based on a landmark study (GISSI Prevention study) published in the prestigious Lancet journal.

In the same study, mortality or death risk was reduced by 20 percent, and cardiovascular death risk by 30 percent.  This is a big reassurance to patients like Rey.

Aside from reducing the risk of sudden death, research evidence from well designed scientific researches consisting of multiple large-scale population studies and randomized controlled trials show that intake of recommended amounts of polyunsaturated fatty acids (PUFA) in the form of dietary fish or fish oil supplements lowers blood triglycerides, risk of heart attack, dangerous abnormal heart rhythms, and strokes in people with known cardiovascular disease.

Cost-effectiveness studies published in the Pharmacoeconomics journal have also shown that long-term treatment with PUFA is comparable with some statins, cholesterol-lowering drugs which are now established as routine care in the secondary prevention after a heart attack.

Known CVD risk factors are smoking, high blood pressure, diabetes, elevated cholesterol levels, obesity and persistent uncontrolled stress. Some of these risk factors can cluster together in the same individual in what is now known as the metabolic syndrome. Patients with definite metabolic syndrome carry an alarming risk of developing heart attack, stroke and premature death. Heart experts believe that omega-3 fish oil can benefit these high-risk patients.

Several well-conducted randomized controlled trials published in prestigious international journals report that in people with a history of heart attack, regular consumption of fish oil reduces the risk of non-fatal heart attack, fatal heart attack, sudden death, and all-cause mortality (death due to any cause). The majority of patients in these studies were already using conventional heart drugs, suggesting that the benefits of fish oils may add to the effects of other established therapies for CVD.

The clinical benefits of fish oil have been reported after three months of use, and these benefits persist up to 3.5 years of follow-up. The beneficial effects of fish oils have been attributed to various mechanisms including reduced triglyceride levels, reduced inflammation in the arteries causing atherosclerosis or narrowing, slightly lowered blood pressure, reduced blood clotting, and reduced tendency of the heart to develop abnormal rhythms.

Other benefits attributed to regular intake of fish oil include alleviation of symptoms of rheumatoid arthritis, improvement of brain function, and protection of kidneys in transplant patients receiving immunosuppressive therapy.

Omegabloc is one of the brands of omega-3 fish oil locally available in Mercury and other leading drug stores. It has been available in the country for more than 10 years and is now prescribed by many doctors. Usual recommended dose is one softgel two to three times daily.

Although classified as a food supplement, doctors have been prescribing Omegabloc as a supplement in high-risk heart patients.