Atrial Septal Defect (ASD): Symptoms, Causes and Treatment
Statins May Lower Risk For Heart Disease And Death, Even In Very Old Adults
Statins are medications that reduce LDL cholesterol levels, otherwise known as "bad" cholesterol.
LDL cholesterol may lead to deposited plaques in blood vessels, hardening and narrowing them and reducing healthy blood flow. It is a contributing factor to atherosclerosis and heart disease.
Research on treating and preventing other heart disease-related conditions with statins is ongoing.
Now, a new study from researchers at the University of Hong Kong found that statins may lower the risk of all-cause and cardiovascular deaths among older people.
The findings show a decrease in mortality among people 60 years of age and older — including people over the age of 85 — who took statins.
The study is published in Annals of Internal Medicine.
According to the Centers For Disease Control and Prevention (CDC), heart disease is the leading cause of death for people 65 years and older.
Recent estimates show that in 2019, the heart disease-related mortality rate among people ages 60 to 80 was 77–80%, and 85% for people over 80. For people ages 40 to 60, 35–40% died of heart-related disease.
To find out whether statin use could help lower death risk from heart disease among older adults in these age groups, the authors of the new study analyzed electronic medical records at the Hong Kong Hospital Authority. The individuals included in the analysis had not previously used statins or lipid-lowering drugs and had no history of cancer.
Researchers tracked specific statin drugs and outcomes. The people were treated at the hospital from January 2008 to December 2015. Where possible, individuals were followed until death or until the study concluded.
People were excluded from the study who had been diagnosed with myopathy and liver issues. There have been reports linking statins to these problems, though experts say these adverse effects are highly unlikely for most statin users.
The new study supports this conclusion, finding no link between statins, myopathy, muscle pain, or liver dysfunction, another possible adverse effect of the drugs.
The reduction in all-cause deaths is likely due to statin use and prevention of cardiovascular events, which comprise a high percentage of all deaths.
Cheng-Han Chen, MD, of Saddleback Medical Center, CA, not involved in the study, explained that cholesterol in the body comes from two sources.
"Some of it comes from the food we eat, but a lot of it is made by the liver," Chen told Medical News Today.
Chemically, statins "inhibit an enzyme called HMG0CoA reductase. This enzyme is critical for cholesterol synthesis in the liver," said Jayne Morgan, MD, cardiologist and the executive director of Health and Community Education at the Piedmont Healthcare Corporation in Atlanta, GA. Morgan was likewise not involved in the study.
Chen explained statins work by decreasing the amount of cholesterol made by the liver.
"By doing that, it decreases your total circulating blood cholesterol levels," he said. Statins do not affect dietary cholesterol.
As such, statins, such as Lipitor, Zocor, and Crestor, help people avoid cardiovascular disease.
Heart disease is an umbrella term for several conditions that result from a partially or totally impeded blood flow to the heart or brain:
Chen noted an additional benefit of statins is they "directly stabilize the plaques so that they're less prone to rupture, a cause of sudden heart attacks in people."
Morgan added that statins are "further thought to decrease the risk of heart disease by a modest effect on increasing the HDL [cholesterol] and decreasing inflammation."
Chen said the new study adds to a body of evidence supporting the value of statins. "Many large-scale studies have demonstrated a benefit for statins in all-cause mortality," he said, noting cardiovascular deaths in particular.
Morgan told MNT that statins may be prescribed to adults at risk for heart disease starting around 18 years of age, especially among people with a history of familial hypercholesterolemia or dyslipidemias (high LDL cholesterol) or other genetic lipid disorders.
"Primary prevention may be considered in those without heart disease but with risk factors such as family history, hypertension, diabetes, smoking, and elevated cholesterol. This helps to mitigate the risk of fatal cardiovascular events," Morgan said.
"Secondary prevention may be considered for those who have already suffered a heart attack in mitigating the risk of further cardiac events in this-high risk population," she noted.
Some statin users report muscle cramps or weakness after using statins and may be reluctant to take them or may stop taking the medications. These symptoms are called Statin-Associated Muscle Symptoms or "SAMS."
One study found that among former statin users, 62% quit taking the drugs due to SAMS.
The American College of Cardiology reports that the occurrence of SAMS tends to be low in randomized controlled trials, although higher in observation studies.
According to the National Lipid Association (NLA), the actual incidence of SAMS is about 10%. The NLA holds that while such symptoms may be actual, they are likely not caused by statin use.
"Occasionally, patients will mention muscle discomfort," Dr. Chen said. "If we ever see any of these adverse effects, we would try switching the patient to a different statin and to see if that helps [resolves] symptoms."
Fish Oil Supplements May Raise Your Risk Of Heart Disease And Stroke If You're Healthy
Fish oil derived from fatty fish like salmon, mackerel, and trout is often recommended for its anti-inflammatory effects, especially in people with cardiovascular disease (CVD), high blood pressure, abnormal lipids, and rheumatoid arthritis.
Fatty fish are a great source of two omega-3 fatty acids that the human body needs but cannot make for itself: docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).
However, while it might seem like a good idea for healthy people to also supplement with fish oil to help prevent disease, the results of a large, long-term study published on May 21, 2024, in the journal BMJ Medicine, indicate that this may not be the case.
The researchers found that using fish oil on a regular basis might actually increase the risk for healthy people to go on and develop first-time heart disease and stroke.
Regular use did, however, help slow the progression of existing CVD. It also helped reduce their risk of death.
The researchers included 415,737 people from the UK Biobank study.
Over half (55%) of the participants were women, and their ages ranged from 40 to 69.
The information collected about the individuals included their use of fish oil supplements and their dietary intake of oily and non-oily fish.
People's health was tracked until either their death or the end of the study in March 2021.
About a third of people said they used fish oil supplements on a regular basis, with the majority of them being older, white, and female.
Among those who had no known CVD at the start of the study, regular usage of fish oil supplements was linked with a 13% increased risk of developing atrial fibrillation and a 5% greater risk of having a stroke.
However, those regular users of fish oil who had CVD at the beginning of the study saw a 15% lower risk of going from atrial fibrillation to a heart attack and a 9% lower risk of progressing from heart failure to death.
Dr. Michael O. McKinney, primary physician at Healthy Outlook in Jacksonville, Florida, explained that the omega-3 fatty acids found in fish oil supplements have been widely studied and found to have both anti-inflammatory and lipid-lowering effects.
"In individuals with established CVD, these properties can stabilize atherosclerotic plaques, lower levels of serum triglycerides, and improve endothelial function, thereby reducing cardiovascular adverse events," he said.
McKinney noted, however, that the situation is not quite so straightforward when people are in good health.
"Their potential merits at high doses of omega-3s could enhance the risk of bleeding by their anticoagulant effects outweighing benefits in individuals lacking significant cardiovascular disease risks," he stated.
Taking fish oil supplements when you are healthy could also result in fatty acid imbalances, perhaps inadvertently increasing a person's risk for heart disease, according to McKinney.
Dr. Sarah Bonza, a board certified family physician and founder of Bonza Health in Columbus, Ohio, said another factor to consider is that some research has suggested that fish oil might increase healthy people's risk for atrial fibrillation, a heart rhythm disturbance linked with greater stroke risk.
"However, for people with preexisting poor cardiovascular health, omega-3s indeed have anti-inflammatory and plaque-stabilizing effects," she added, "which help in slowing the progression of cardiovascular disease and in reducing the chances of death from heart-related events.
"So, these advantages may be more than the hazards in patients with weakened cardiovascular systems," said Bonza.
"If you are healthy and you seek to use fish oil capsules for preventing heart disease, it might be better to think over your decision," said Bonza.
She further stated that the American Heart Association does not advocate taking omega-3 supplements if you are at low risk for CVD because the effects are "far more enhanced" in those with the disease.
Instead, Bonza suggests eating a heart-healthy diet with plenty of natural omega-3 sources, such as fish.
In her opinion, this will be more beneficial to your health.
"On the other hand, personal health condition factors differ, so it is important to talk to a healthcare provider first before choosing to modify supplement consumption," she added. "Talk to your doctor first to be safe."
Bonza said she would recommend supplementing with flaxseed oil or chia seeds instead of fish oil due to their high alpha-linolenic acid (ALA) content. This is a plant-based omega-3 fatty acid, she explained.
She suggests augmenting your diet with this type of fatty acid because it might have anti-inflammatory properties that can benefit your cardiovascular health, but it is not associated with the risk of atrial fibrillation.
"Also, the diet that contains omega-3s in the form of nuts, soy products, and fortified food will provide the same benefits without high-dose supplements," she added.
McKinney additionally suggests supplementing with other heart-supporting supplements, such as Coenzyme Q10 (CoQ10), and fiber supplements, such as psyllium husk.
"In addition, everyone has to consult their healthcare providers so that individual patients adjust their choices of supplementation corresponding to their health problems and peculiarities," he concluded.
A new study has found that fish oil supplementation was associated with an increased risk of developing heart disease and stroke in healthy people.
However, people with existing CVD experienced protective effects against further progression of their disease.
This was an observational study. It does not prove causation.
Experts say the difference in how fish oil affects people's risk might be due to the fact that in healthy people, the risks associated with fish oil supplementation — such as bleeding, fatty acid imbalance, or atrial fibrillation — might outweigh any potential benefits.
For healthy people, it may be best to get omega-3 fatty acids from foods like fatty fish.
Flaxseed oil, chia seeds, foods fortified with omega-3 fatty acids, CoQ10, and psyllium husk may be safer supplements for cardiovascular health.
Regular Use Of Fish Oil Supplements May Increase First Time Heart Disease And Stroke Risk
Fish oil, a source of omega-3 fatty acids commonly used to reduce cardiovascular risk, might actually increase the risk of heart attack and stroke among people who have good cardiovascular health.
Researchers from China say they have found an association between use of fish oil supplements and heightened cardiovascular risk among heart-healthy individuals even as the study showed benefits of the supplements for those with poor cardiovascular health.
"These findings indicate that the recommendation of fish oil should be more selective and tailored to individual patient profiles," said Dr. Adedapo Adeyinka Iluyomade, a preventative cardiologist with the Baptist Health Miami Cardiac & Vascular Institute in Florida who was not involved in the research.
"Fish oil may be more beneficial for patients with preexisting cardiovascular conditions rather than for primary prevention in the general population," he told Medical News Today.
The study, which was published in the journal BMJ Medicine, was drawn from data on 415,737 people in the UK Biobank, about a third of whom took fish oil supplements.
Researchers reported that individuals with no known cardiovascular disease who regularly took fish oil supplements had a 13% higher risk of developing atrial fibrillation and a 5% higher risk of having a stroke than those who had good heart health but didn't use fish oil.
However, researchers added that individuals who had cardiovascular disease and used fish oil supplements had a 15% lower risk of progressing from atrial fibrillation to a heart attack and a 9% lower risk of progressing from heart failure to death.
The risk of transitioning from good health to heart attack, stroke, or heart failure was 6% higher among women who took fish oil as well as 6% higher among non-smokers. The protective effect of fish oil on the transition from good health to death was greater in men and older study participants.
"Regular use of fish oil supplements might have different roles in the progression of cardiovascular disease," the study authors wrote.
Iluyomade noted that fish oil supplements containing omega-3 fatty acids are widely used for cardiovascular risk reduction.
"Many patients take them for primary or secondary prevention of heart disease based on the belief they have cardiovascular benefits," he said. "This usage is based on the idea that omega-3 fatty acids have anti-inflammatory properties and can help improve lipid profiles."
"Omega-3 fatty acids lower triglyceride levels, decrease blood pressure, and reduce inflammation," said Dr. Rohit Vuppuluri, a cardiologist at the Drs. Sawlani and Sukenik Group in Chicago who was not involved in the study. "However, when fish oil is recommended for medical treatment, it should be consumed using a prescription-grade fish oil rather than over the counter fish oil. This ensures the fish oil is medical grade quality."
"Eating salmon regularly is also a great source for omega-3 fatty acids," Vuppuluri told Medical News Today.
Like the current study, past research on the benefits of fish oil has been mixed.
"While some studies and meta-analyses have suggested benefits, such as reduced risk of heart attack and sudden cardiac death, others have shown minimal or no significant impact on overall cardiovascular mortality," said Iluyomade.
"This study is very interesting and the findings worthy of further exploration, but I still recommend that patients get at least 500mg [of] omega-3s per day, whether from eating fatty fish, taking an omega-3 supplement, or a combination of the two," said Elana Natker, a registered dietitian and director of consumer and health professional communications for the Global Organization for EPA and DHA Omega-3s, an industry trade group.
"While this study was on a large population, it was observational in nature with potential confounding factors and no consideration of dose," Natker, who was not involved in the research, told Medical News Today. "Meta-analyses of human clinical trials have found statistically significant reductions in hearth attack and death from heart attack and coronary heart disease."
The study authors wrote that "further studies are needed to determine the precise mechanisms for the development and prognosis of cardiovascular disease events with regular use of fish oil supplements."
Natker said that human clinical studies are needed to suggest a causal relationship between omega-3s and atrial fibrillation.
"While concerns have been raised about the effects of omega-3 fatty acids to increase the risk of atrial fibrillation, little or no increase has been seen with daily dosages less than one gram," she said.
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