Dr. Harrison said he believed that people should generally increase their intake of omega-3 acids, best done by eating more fish. Still, he acknowledged that it was difficult to eat foods containing a gram of omega-3 acids each day. If you ask me do I take omega-3 supplements every day, then, embarrassingly, the answer is yes, said Dr. Harrison, a professor at Bolton Primary Care Trust of the University of Manchester in England.
I, too, am caught up in this hectic world where I have little time to shop and prepare the healthy foods I know I should be eating, he said. It seems natural for Italy to be at the forefront of the fish oil trend and home to the largest clinical trials. Scientists have long noted that Mediterranean diets are salubrious for the heart and theorized that the high content of broiled and baked fish might be partly responsible.
But the landmark Gissi-Prevenzione trial of fish oil had methodological weaknesses: the patients treated with prescription fish oil pills were compared with untreated patients, rather than with patients given a dummy pill. This meant that, despite impressive results, the trial did not meet the F.D.A.s standards for approval. Yet by 2004, regulators in almost all European countries, including Spain, France and Britain, had approved Omacor for use in heart attack patients.
Marylou Rowe, a spokeswoman for Reliant Pharmaceuticals, which owns the license for the drug in the United States, said that further trials of Omacor would be needed for it to be licensed for heart attack patients in the United States. But she refused to discuss a timetable. The American College of Cardiology now advises patients with coronary artery disease to increase
their consumption of omega-3 acids to one gram a day, but it does not specify if this should be achieved by eating fish or by taking capsules. But over-the-counter preparations of fish oil have much less rigorous quality control and are often blends of the two fish oils know to be beneficial in heart disease with other less useful fatty acids.
For that reason, Dr. Jacobson of Emory gives the prescription drug, off label, to cardiac patients, even though the F.D.A. has not approved it for that use. Then I know exactly what theyre getting, and there is no mercury, he said.
He said he tells patients who cannot afford the prescription version that they can take the over-thecounter supplements, although there is uncertainty about the dose and they probably need three to four pills a day.
In Europe, meanwhile, research on prescription fish oil, which is now thought to act by stabilizing cell membranes, has gained momentum. The Gissi Group is conducting two huge trials using fish oil in patients with abnormal heart rhythms and in patients with heart failure.
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