Omega-3 fatty acid supplementation not associated with lower risk of major CVD events

In a study that included nearly 70,000 patients, supplementation with omega-3 polyunsaturated fatty acids was not associated with a lower risk of all-cause death, cardiac death, sudden death, heart attack, or stroke, according to an analysis of previous studies published in the September 12 issue of JAMA.

12 sept 2012--"Treatment with marine-derived omega-3 polyunsaturated fatty acids (PUFAs) for the prevention of major cardiovascular adverse outcomes has been supported by a number of randomized clinical trials (RCTs) and refuted by others. Although their mechanism of action is not clear, their postulated effect on cardiovascular outcomes may be due to their ability to lower triglyceride levels, prevent serious arrhythmias, or even decrease platelet aggregation and lower blood pressure. Current guidelines issued by major societies recommend their use, either as supplements or through dietary counseling, for patients after myocardial infarction [MI; heart attack], whereas the U.S. Food and Drug Administration has approved their administration only as triglyceride-lowering agents in patients with overt hypertriglyceridemia, and some (but not all) European national regulatory agencies have approved the omega-3 administration for cardiovascular risk modification. The controversy stemming from the varying labeling indications causes confusion in everyday clinical practice about whether to use these agents for cardiovascular protection," according to background information in the article.

Evangelos C. Rizos, M.D., Ph.D., of the University Hospital of Ioannina, Ioannina, Greece, and colleagues performed a large-scale synthesis of the available randomized evidence by conducting a systematic review and meta-analysis to determine the association between omega-3 PUFAs and major cardiovascular outcomes.

Of the 3,635 citations retrieved, 20 studies with 68,680 randomized patients were included, reporting 7,044 deaths, 3,993 cardiac deaths, 1,150 sudden deaths, 1,837 heart attacks, and 1,490 strokes. Analysis indicated no statistically significant association with all-cause mortality,cardiac death, sudden death, heart attack, and stroke when all supplement studies were considered.

"In conclusion, omega-3 PUFAs are not statistically significantly associated with major cardiovascular outcomes across various patient populations. Our findings do not justify the use of omega-3 as a structured intervention in everyday clinical practice or guidelines supporting dietary omega-3 PUFA administration. Randomized evidence will continue to accumulate in the field, yet an individual patient data meta-analysis would be more appropriate to refine possible associations related to, among others, dose, adherence, baseline intake, and cardiovascular disease risk group," the authors conclude.

More information: JAMA. 2012;308[10]:1024-1033.

Provided by JAMA and Archives Journals

Global study suggests need for strategies to combat unhealthy lifestyles among the poor and the rich

Healthy foods such as fruits and vegetables, proteins and total fats are consumed more often by the wealthy while poorer people consume more carbohydrates, says a new study involving people from 17 countries.

26 aug 2012--The Prospective Urban Rural Epidemiology (PURE) study involving 154,000 individuals from 628 communities reported on the patterns of diet, physical activity and smoking, was presented at the European Society of Cardiology 2012 Congress on Sunday, Aug. 26, 2012.

The study found individuals who were poor, or from poorer countries were more active chiefly because of higher energy expenditure in jobs, at home, and during transportation.

The markedly lower level of obligatory physical activity was not compensated for by higher levels of recreational physical activity in richer countries or richer individuals. Those who were rich and those in richer countries quit smoking much more often so that rates of smoking was lower in the wealthier individuals and wealthier countries.

"Policies to prevent cardiovascular disease need to focus on different aspects of lifestyle among the rich versus the poor and between rich and poor countries," said professor Salim Yusuf of the Population Health Research Institute, McMaster University and Hamilton Health Sciences and principal investigator of the study.

The study was conducted in 17 countries and coordinated worldwide by the Population Health Research Institute and supported by the Canadian Institutes of Health Research, the Indian Council of Medical Research, several other peer review organizations and pharmaceutical companies.

"These results provide new insights into the need to customize prevention policies differently for the rich and the poor and for countries at different economic levels," said professor David Wood of the University of London, UK and an expert in cardiovascular disease prevention.

Provided by McMaster University

New AHA Statement Totes Benefits of Resistance Training for Cardiovascular Health

July 20, 2007 — A new AHA scientific statement summarizing recommendations for resistance training in people with and without cardiovascular disease (CVD) should serve as a reminder to clinicians that there are "singular" benefits to improving muscular strength in addition to regular aerobic exercise, experts say. Dr Mark Williams (Creighton University, Omaha, NE) who led the writing group, told heartwire that there is important new information in the statement, that updates the original resistance training guidelines of 2000.
Despite this being the second set of recommendations on this topic to come from the American Heart Association (AHA), Williams says physicians may still overlook resistance exercise — lifting weights, or exerting force against resistance — as part of cardiovascular (CV) fitness regimen.
"Telling someone to exercise typically does either directly or indirectly suggest that they should be doing more walking," he told heartwire. "I don't think resistance training is frequently thought of as part of an overall exercise program."
The statement was published in a rapid access issue of Circulation, July 16, 2007.
Resistance Training Additive to Aerobic Exercise
The statement reviews the health benefits of resistance training and its impact on the CV function. It also summarizes the role of resistance training in modifying CVD risk factors, its benefit in specific CVD populations, and provides recommendations on evaluating patients prior to starting a resistance training regimen and suggestions for how such a regimen could be prescribed.
Williams highlighted a table in the AHA statement that compares the effects of aerobic activities and resistance training on different parameters, noting that some clinicians may be unaware of the differential effects. For example, while aerobic exercise can have moderate effects on percent body fat, compared with merely a small effect of resistance training, resistance training has moderate effects on lean body mass, and major effects on muscle strength, while aerobic exercise has no effect, and minimal effects, respectively. By contrast, both aerobic and resistance exercise produce similarly small effects on high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, while aerobic exercise has greater effects than resistance training on triglycerides. Importantly, both forms of exercise can have similar effects on quality of life.
Williams pointed out that the importance of resistance training is now fairly well recognized in cardiac rehabilitation programs, but its benefits are less commonly appreciated in primary prevention. He also highlighted the role of resistance training in groups where it has been used the least: in older women, the elderly, and in patients with heart failure.
"People with heart failure have significantly dysfunctional hearts and as a result of that, their peripheral musculature and their ability to get around and do the things they need to do is significantly and negatively impacted by the fact that they have heart failure," Williams said. "We have been including patients with heart failure in our aerobic cardiac rehabilitation programs, but now there are data to suggest that patients, under appropriate evaluation and supervision, can improve functional capacity, physical strength, endurance, and quality of life by incorporating some resistance training into their exercise programs, too."
Just Do It — Correctly
Proper instruction and technique is essential for anyone beginning resistance training for the first time, but it is especially important for people with existing cardiovascular disease, Williams noted.
"Patients who come into cardiac rehabilitation programs typically get that kind of instruction, but people who are not participating in those formal kinds of programs should get in touch with an exercise specialist, or a physical therapist to provide some input on how to be doing resistance training properly. And the key there is that patients who do have cardiovascular disease need to identify themselves as such, so people don't assume they are healthy and give them instructions that would be inappropriate."
Of note, Williams added, in all of the research to date, there are almost no reports of significant adverse effects of resistance training, although these were all supervised, controlled studies where risk is minimized. "The downsides are there, but the upsides are greater, and the downsides appear mostly to be related to the fact that people do things they shouldn't be doing, or don't seek advice or evaluation prior to starting," he said.
The authors have disclosed no relevant financial relationships.
Circulation. Published online July 16, 2007.

Simultaneous Better Than Sequential Behavioral Counseling in CVD Prevention

June 15, 2007 — Addressing more than 1 behavioral change at a time — so-called simultaneous counseling — is probably more effective than sequential counseling, which tries to tackle changes one by one, a new study has found.
Dr David J Hyman (Baylor College of Medicine, Houston) and colleagues report their findings from a high-risk group of patients with hypertension in a primary care setting in the June 11 Archives of Internal Medicine.
"There are multiple behaviors people have to change for primary or secondary prevention, and getting people to change is tough," Hyman told heartwire. "There seems to be a deep-seated belief amongst physicians that if someone has multiple behaviors to change then you should only work on one at a time. But there is surprisingly little evidence to support that. So it occurred to us that if there are so many people who need to change so many things, why not see if there is a difference?"
No Remarkable Behavioral Change
Hyman and colleagues randomly assigned 289 African-American patients aged 45 to 64 years who had hypertension and were smokers to 1 of 3 groups that encouraged them to: stop smoking, reduce their sodium intake to less than 100 mEq/L per day, and increase physical activity by at least 10,000 pedometer steps per week.
The first group received 1 in-clinic counseling session on all 3 behaviors every 6 months, plus motivational telephone calls for 18 months; the second group followed a similar protocol, but addressed a different behavior every 6 months; and the third group received usual care, consisting of a one-time referral to existing group classes. After six, 12 and 18 months, urine and blood samples were obtained, blood pressure was taken and behavioral changes were assessed.
The primary endpoint was the proportion in each arm that met at least 2 of the 3 behavioral criteria after 18 months. A total of 230 participants completed the full study. At 18 months, only 6.5% in the simultaneous arm, 5.2% in the sequential arm and 6.5% in the usual-care arm met the primary end point.
"Unfortunately," Hyman admitted to heartwire, "there wasn't really any remarkable behavioral change in the study, but it didn't look like one at a time was superior and, if anything, it looked like asking for everything at once was better."
Single Behavioral Goals: Simultaneous Approach Much Better
"The goals we set were pretty ambitious," he added, "and because not many people achieved [the primary endpoint] we decided to also look at trends for single behavioral goals, and these consistently favored the simultaneous group."
For example, after 6 months, 29.6% in the simultaneous, 16.5% in the sequential, and 13.4% in the usual-care groups had reached the urine sodium goal (P = .01). After 18 months, 20.3% in the simultaneous, 16.9% in the sequential and 10.1% in the usual-care groups tested negative for urine cotinine (P = .08), an indication that they had stopped smoking.
"We have to admit, that although the evidence is limited, and we still need far better ways to get individuals to change behavior, there doesn't seem to be any reason not to try everything at once," Hyman concluded. "There's no harm in a little internal consistency at times — if you're trying to eat right, does it really make much sense to be smoking a cigarette?"
Arch Intern Med. 2007;167:1152-1158.