Why Take Fish Oil If You Take a Statin Drug?

Health Professional

Several months ago, I had asked Maureen to add fish oil to her heart disease prevention regimen.

"My primary doctor said that I should stop taking fish oil. He say's that I don't need it because I take a cholesterol drug. He says that the cholesterol drug is more than enough."

Is this true? If someone takes a statin drug, like Crestor ®, Lipitor ®, Zocor ® (simvastatin), Pravachol ®, or lovastatin, they don't need to take anything else because the statin drug is so powerful that it eliminates risk?

No. It's not even close to the truth.

First of all, let's accept that virtually all statin drug researchhundreds of studies, billions of dollars spentwas paid for by the pharmaceutical industry. It's no news that studies paid for by the sponsor are likely to favor the sponsor. Imagine Ford sponsored a study of Ford vs. GM cars vs. Toyota, paying $10 million to fund the effort. Guess who is likely to come out on top? "Studies show that Ford makes the best car in America." (Sorry, I don't mean to pick specifically on Ford. It's just a widely-recognized brand.)

It doesn't necessarily mean that the data don't contain some truth. But it likely means that the statin literature potentially overestimates the benefits of statin drugs. Even so, it's clear from the hundreds of studies performed that the best we can hope for by taking a statin drug is reduction of heart attack and death from heart disease of 30-35% best case.

That doesn't sound like elimination of risk to me.

What are the incremental benefits of adding omega-3 fatty acids from fish oil added to statins? The best data are from the JELIS Trial (Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis), in which 19,000 Japanese participants experienced a 19% reduction (relative reduction) in cardiovascular events when 1800 mg of EPA (alone) was added to a statin drug. What makes this study especially remarkable is the fact that it occurred in the Japanese, whose intake of omega-3 from diet is already fairly high, usually ranging from 1800-3000 mg EPA + DHA per day. Benefits for less vigorous fish eating cultures, like us, would be expected to be even greater.

Omega-3 fatty acids from fish oil also:

Reduce triglycerides dramatically - an effect that is dependent on the dose of EPA + DHA used.

Accelerate after-eating clearance of digestive by-products, i.e., they correct post-prandial abnormalities. Post-prandial abnormalities are potent causes of carotid and vascular disease.

Modify the character (fragmentation potential, structural strength) of plaque. People taking fish oil have firmer, more stable, less fragmentable plaque.

Raise HDL modestly - If you buy fish oil from Sam's Club, Costco, or other discounter, a healthy dose of fish oil might cost you $3 per month. Compare that to the $120 per month average cost of a statin agent.

So, do statin drugs make omega-3 fatty acids from fish oil irrelevant? Absolutely not. Adding omega-3 fatty acids from fish oil, or eating fish permits us to inch closer and closer not to reductionbut towards elimination of risk for heart disease.