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Providing perspectives on recent research into vitamins and nutritionals


How Would You Change Your Behavior If You Had a Heart Attack?

By Julia Bird

Good advice about healthy behaviors is everywhere. Even if we don’t want to look for it on our own, public service announcements sent out on the radio and on the television try to get us off the sofa, well-meaning Facebook friends chronicle their weight-loss and can’t help but try to convince others to follow the same path, and even packets of food extol the virtues of a balanced diet and regular physical activity. Starting from now, we can all make changes that will have a positive impact on our health and quality of life. But sometimes we need a major trigger, a lightning bolt, to illuminate a better way forward.

One life event that is sure to prompt a critical review of our current lifestyle is having a heart attack. Harris and co-workers recently investigated differences between people who made the heart-healthy choice to begin omega-3 supplementation within the month after a heart attack, with those who did not. They used data from the TRIUMPH study, which is  a prospective cohort study that collects data on people who had just experienced an acute myocardial infarction, in 24 centers in the US. The authors were interested in people who were not using fish oil supplements when they had a heart attack (around 20% were already using fish oil supplements). The authors looked at a wide variety of characteristics of the subjects to work out whether there were differences in people who decided to use supplements after a heart attack.

They found that 16% of people not using fish oil supplements started using them in the first month after discharge from hospital. They found that people who started to use fish oil supplements were more likely to:

-          Be younger

-          Have a stable family life

-          Be financially secure

-          Have a better GRACE risk score (better prognosis after a heart attack)

-          Have better physical capacities

-          Be engaged in mild to moderate exercise

-          Have a diet higher in omega-3

-          Use statins at discharge and participate in a cardiac rehabilitation (perhaps related to their greater rate of health insurance usage)

-          Have a family history of coronary artery disease

In addition, fish oil supplementation initiators were less likely to:

-          Smoke

-          Eat fast food

-          Abuse alcohol

-          Have certain co-morbidities such as diabetes and chronic kidney disease

So, it seems that even though a heart attack seemed to be a trigger for people to start consuming fish oil supplements, there were clear differences between people who did and did not initiate supplement use. The general difference was that people who were healthier to start with were more likely to take supplements. Herein lies one of the issues with performing clinical trials in general, and may explain why results from omega-3 trials in recent years have been less successful than ones performed before awareness of omega-3 for heart hit the mainstream (Marchioli): trials were done in people who already had an adequate intake. A further confounding factor may be the better health status of clinical trial participants in general (see studies from groups lead by Costenbader, Elting and de Jong for some examples).

So it seems that having a heart attack can be a further incentive to make healthy choices, however other factors contribute to the likelihood of making a change. And in addition, for 84% of participants, having a heart attack was not an incentive to take omega-3 supplements. It seems that having a heart attack is not the call-to-action that one might expect.

Main citation:

William S. Harris, K.F. Kennedy, T.M. Maddox, S. Kutty, J.A. Spertus. Multiple differences between patients who initiate fish oil supplementation post–myocardial infarction and those who do not: the TRIUMPH Study. Volume 36, Issue 1, January 2016, Pages 65–71. doi:10.1016/j.nutres.2015.11.006

Supporting citations:

Costenbader KH, Brome D, Blanch D, Gall V, Karlson E, Liang MH. Factors determining participation in prevention trials among systemic lupus erythematosus patients: a qualitative study. Arthritis Rheum. 2007 Feb 15;57(1):49-55.

Elting LS, Cooksley C, Bekele BN, Frumovitz M, Avritscher EB, Sun C, Bodurka DC. Generalizability of cancer clinical trial results: prognostic differences between participants and nonparticipants. Cancer. 2006 Jun 1;106(11):2452-8.

de Jong Z, Munneke M, Jansen LM, Ronday K, van Schaardenburg DJ, Brand R, van den Ende CH, Vliet Vlieland TP, Zuijderduin WM, Hazes JM. Differences between participants and nonparticipants in an exercise trial for adults with rheumatoid arthritis. Arthritis Rheum. 2004 Aug 15;51(4):593-600.

Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R, Franzosi MG, Geraci E, Levantesi G, Maggioni AP, Mantini L, Marfisi RM, Mastrogiuseppe G, Mininni N, Nicolosi GL, Santini M, Schweiger C, Tavazzi L, Tognoni G, Tucci C, Valagussa F; GISSI-Prevenzione Investigators. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation. 2002 Apr 23;105(16):1897-903.

Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012 Sep 12;308(10):1024-33. doi: 10.1001/2012.jama.11374.