The People's Perspective on Medicine

Will Prescription EPA Prevent Heart Attacks?

Researchers report that a prescription EPA (purified omega-3 fat from fish oil) can reduce the risk of heart attacks, but not the chance of dying.

Vascepa is a prescription pill containing one of the types of omega-3 fatty acids found in fish oil (eicosapentaenoic acid, or EPA for short). This medication, icosapent ethyl, is prescribed for people with stubbornly high triglycerides. High triglycerides are an independent risk factor for heart disease. So will this prescription EPA prevent heart attacks?

Studying Prescription EPA:

Researchers reported that people taking Vascepa are 25 percent less likely than those on placebo medicines to suffer a heart attack, stroke, or other serious heart problem. The principal study included more than 19,000 people with heart disease or serious risk factors for heart disease. More than 8,000 of these volunteers participated in the placebo-controlled trial called REDUCE-IT. 

About 6 percent of those on Vascepa suffered a heart attack during the year-long study, compared to 8.7 percent of those on placebo. Serious side effects included atrial fibrillation and severe bleeding events. The investigators presented their findings at the American College of Cardiology Scientific Meeting in New Orleans, LA, on March 18, 2019.

Previous Findings from the REDUCE-IT Study:

An earlier report on the REDUCE-IT trial was published a few months ago in The New England Journal of Medicine (Jan. 3, 2019).

This randomized placebo-controlled trial included more than 8,000 high-risk patients for nearly five years. These people had heart disease or diabetes and high triglycerides despite being treated with statins.

About 17 percent of the volunteers taking icosapent ethyl had a heart attack, stroke, death from cardiovascular complications or hospitalization for heart procedures. In comparison, 22 percent of those on placebo suffered one of these events.

Fewer People Died:

The most important outcome of any trial is mortality. Did the treatment keep people from dying prematurely?

The previous report showed that fewer people taking Vascepa died from cardiovascular causes. The totals were 4.3 percent instead of 5.2 percent of those on placebo. With more follow-up, the current report demonstrates 9.6 of those on Vascepa vs.12.4 percent of those on placebo died of heart attacks or other cardiovascular complications. This difference is significant. On the other hand, the difference in overall mortality was not significant.

In summary, the bottom line appears to be that prescription EPA (eicosapentaenoic acid) has cardioprotective activity. However, the effect may not be powerful enough to cheat death.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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  • Bhatt et al, "Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia." New England Journal of Medicine, Jan. 3, 2019. DOI: 10.1056/NEJMoa1812792
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I, too, cannot take statins but this prescription fish oil was intolerable also. I am 71 and am managing without any of them. My cholesterol elevation seems to be my heredity.

Is this the same as Lovaza? I took Lovaza for 2 years, and my triglycerides only went down by 10 points. I also took Niaspan to work on cholesterol since I could not tolerate statins. That effect was the same – decrease of 10 points. But, my glucose and A1C levels both went up to pre-diabetes levels as was mentioned in the statin/diabetes article. So I quit taking both of them.

I have a deathly allergy to all tree nuts, and I find all types of seafood very unpleasant to eat, no matter how they are prepared. But my cholesterol went down 40 points when I started to add millet to my home made granola; oats, millet, flax seeds, chia seeds, toasted with a little honey and/or home made peanut butter to coat it so it isn’t so dry. Half cup granola and an apple for breakfast with 1/2 cup plain yogurt, and I’m good until close to dinner time.

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