Comments on NEJM Omega-3 study

A study published yesterday in The New England Journal of Medicine looked at the efficacy of one gram of supplemental omega-3 fish oil on older diabetic patients with a history of a cardiac event. Not surprisingly, the fish oil did nothing to prevent cardiovascular deaths. How tired is it to keep reading these studies performed on sick people. There are so many holes that can be blown in this study it is hard to know where to begin. At least the authors admit this in their discussion of the results.

1. The researchers used the prescription fish oil Omacor, which is ethyl ester-derived. There have been very few positive findings on this brand of fish oil. Most experts in the know believe that triglyceride fish oil, not ethyl ester, is the most efficacious. Most importantly, Omacor contains trans fat in its formula. Because there is no level of safe trans fat, this study should have been considered dead on arrival.
   
2. One gram of fish oil is considered a daily maintenance dose. The dose required to treat people with diabetes and previous cardiovascular events is 3-4 grams daily.
   
3. These patients were on at least one diabetes medication and other heart medications which were not divulged. Much of the benefits that could potentially come from the fish oil are negated from the polypharmacy.
   
4. Do I dare even that the study was not double-blind, placebo-controlled? It wouldn't matter. The design of the study renders its structure meaningless.

 Interestingly, the study found that triglyceride levels were significantly reduced in the participants, which is congruent with many other studies when fish oil is prescribed at a one gram daily dose.