Super fish oil Vascepa is it better than regular fish oil
now see here's an interesting thing I saw a patient
earlier this week he's in his late 50s now but he's got a family problem
and he knows it he said Doc in my 20s I had triglyceride levels in the 400s
let me repeat that yes you heard it right in my 20s
Doc in my 20s I had triglyceride levels in
the 400s so what's he been doing and what's his triglyceride level now
it's like it's less than 100 he's doing great work now he is taking a
statin he's taken statins for quite a while
but he's on a fairly low dose statin now he's taking
some fish oil over the counter supplement and that's one of the big
questions that came up he said you know I haven't taken Vascepa
I always felt like is it really that much better than getting
supplements over the counter he's taking three grams
of fish supplements daily and here's one of the
areas where I'd have to say I don't know and you know what the
reality is none of us know the basic indications
for Vascepa first of all again Vascepa is the
prescription-strength fish oil focused entirely on EPA and you know EPA
and DHA are the oils that you want out of omega-3s
you get a lot more stuff in typical fish oils and in fact if you've got fish oil
supplement go get the bottle and look at it and you'll see that
you may get one or two grams and it says oh you get a gram of fish oil but look
to see how much EPA you get in it usually less than a third of a gram
maybe even a quarter of a gram so again very different stuff the
question then is well can I take three or four grams of
the routine fish oil supplement that's actually what I've recommended
that people do and that's what this patient that I'm describing
has been doing recently he's on a low carb diet
of what 20 grams of carbs per day and so he's been doing great work at keeping
his triglycerides easy for me to say huh
triglycerides low now let me go back to the script I'm starting to wonder a
little bit so let me get back so you can follow me if
you have a high triglyceride level there are ways to lower
healthy diet lose weight address medical conditions like prediabetes or diabetes
and again you know I mentioned the triglyceride over HDL ratio
earlier that's a big big deal in terms of this
issue by far the most common reason that you see for elevated
triglycerides is not a family hypertriglyceridemia like I'm describing
in this patient it is that prediabetic diabetic
metabolism and again if you're not sure what we're talking about
go back to the triglyceride over HDL series we just did a couple of videos on
it a couple of YouTube lives on it in some instances particularly in
dyslipidemic patients the doctor may prescribe meds like
Vascepa and yes clearly for folks that have significant
hypertriglyceridemia I have recommended and used that
so again you get back to the patient that we're just talking about and the
question is well should we adjust the statin that he's been taking maybe lower
that some get in a kinder gentler lower dose
of statin and add some Vascepa into it again
nobody really knows the answer to that the standard for indication for Vascepa
is someone who's on statins and still has a triglyceride level 150
or above Vascepa the generic name is icosapent
ethyl or IPE it's a modified form of an omega-3 fatty
acid it's approved for use in the US by the
FDA it was approved in July of 2012 for people with severe
hypertriglyceridemia triglycerides over 500 milligrams per
deciliter the MARINE trial look it up it was in the New England
Journal the MARINE trial was one of the watershed trials for this medication it
was approved for expanded use in December of 2019 for preventing
serious heart complications in high-risk patients
already taking cholesterol lowering meds the REDUCE-IT trial
now I remember talking with several people this patient earlier this week
and a lot of people John for example when John was working
with the channel many of us were very skeptical
about Vascepa when it started hitting the news
last year in 2019 we said again maybe big pharma is just trying to make
money you know doing what big pharma does
take something that has noticed impact like it did with red yeast rice and saying
or red yeast rice I always confuse that term you get
something that has an impact if you're a big pharma and you do a lot
of things to try to improve it and then make it a
prescription drug and that is that exactly what they did
with Vascepa yes of course in many ways that's what
they did so the real question for us though
is not is that what the big pharma did because big pharma did what they're
always going to do the question is is it worth it and if so
in which situations outside of the patient that I'm discussing I've had
plenty of patients with triglycerides 2 and 3 hundred
levels also having significant plaque also having a
significant diabetes prediabetes and also already on a statin those are
patients for whom there is no question Vascepa does make
sense how does Vascepa work it reduces the
amount of triglycerides made in the liver
it increases the removal of triglycerides from VLDL particles
remember again we talked about these processes
back in the triglyceride over HDL ratio discussions
the exact manner by which Vascepa does this is not known
although there have been several mechanisms proposed
one of them is beta oxidation that is oxidation of fatty acids within the
cytosol of the cell another one is just decreasing the liver
production and another one is just decreasing the clotting and
bleeding clotting risk of the blood itself
we're going to go over a couple of trials here real quick for those of you
who like to go over trials the first one is
the MARINE trial that was all all the way back to 2011 so many people
think that icosapent ethyl didn't exist prior in
2019 and all the news that it got last year well it's
been around longer than that MARINE trial
back in 2011 may have been the most pivotal it was a study that checked the
triglyceride lowering the level of icosapent ethyl
at that point known as AMR101 and people with triglycerides of 500 to a 2000
again huge levels they gave them the medication over a 12-week period the
4 grams of Vascepa daily reduce triglycerides by 45%
the 2 grams of Vascepa reduce triglycerides by 33%
it significantly reduced non-HDL cholesterol
ApoB Lp-PLA2 (PLAC2) those of you who remember the inflammation panel
VLDL cholesterol remember those are the very short-lived
very low density lipoproteins you know you got HDL
LDL VLDL and then IDL which is intermediate density lipoproteins
between VLDL and LDL it also significantly reduced
cholesterol total cholesterol so the conclusion at that point of the
MARINE trial was Vascepa significantly reduced
triglyceride levels and improved other lipid parameters
without significantly increasing the LDL in
patients with very high triglyceride levels so that was the
situation up until last year 2019 there was no question at
that point that this stuff was great for those
patients that had really high triglycerides and again
these are genetic issues usually triglyceride levels 500 and
above once you get over 300 you need to start
looking at and thinking about potential for
genetic variations in metabolism super fish oil
Vascepa better than fish oil REDUCE-IT trial this is the second study this was
in 2019 it was also a groundbreaking study
it showed that it lowers your risk of a
life-threatening heart attack or stroke by 25% when added to a statin
it was done on patients with established cardiovascular disease
diabetes or other risk factors these are patients that had been receiving satin
therapy had fasting triglyceride levels of 135
to 499 so again what we've done with the
REDUCE-IT trial is go down a significant amount
you don't find a lot of people with triglycerides over 500
you find a lot of people with triglyceride levels
130 and above they also had LDL cholesterols of 41 to 100
the results were the patients treated with a total of four grams of Vascepa
daily had fewer cardiovascular events 17.2%
compared to those who took a placebo 22% the conclusion was that among patients
with elevated triglycerides despite use of statins the risk of
ischemic events including cardiovascular death was significantly lower
among those who took the two grams of Vascepa
Vascepa two times daily compared to the ones that
received the placebo and again you see some information
it's one of their ads this came out of the New England Journal
article on it Deepak Bhatt you'll see Deepak Bhatt in
a little two-minute video that we have later on in the show
on Vascepa now there's a new trial the EVAPORATE trial and it came from
Matthew Budoff anybody remember him he's often known as
the father of the calcium score coronary calcium score
he did a study it was a small one he enrolled 80 patients aged 30 to 85 years
old with known coronary atherosclerosis and on a stable statin
therapy the patients received four grams of
Vascepa daily or a placebo a multi-detector CT
MDCT scan was done at 9 months followed by a final scan in 18 months
very similar to CT angiogram which we've talked about
many times if you don't if you're not familiar with CT angiogram
just go to our YouTube channel or google YouTube Ford Brewer CT angiogram
compared with placebo Vascepa significantly reduced multiple
plaque components including vulnerable plaque in patients
with elevated triglycerides and on statin therapy now here's one
place where I get a little concerned I have a little
bit of a I don't believe in the term or concept
vulnerable plaque basically and I think that's an over
generalization of the term basically what they were talking about
is soft plaque now that I believe in and there's no question
about it the science is replete with that term soft plaque
and I believe that's what they're referring to here despite the small
sample size Budoff and his colleagues noted benefits of Vascepa
on outcomes in plaque reduction as early as 9 months
with increasing significance by 18 months and here you see
the bar chart to the best of our knowledge this is the first
elegant marriage of clinical trial results REDUCE-IT
and imaging EVAPORATE Budoff said these data highlight the early and
substantial impact of IPE icosapent ethyl
on the atherothrombotic burden in this at-risk
population and again you got the link to the study itself if you'd like to take a
look
so I'd like to talk with you a minute about the webinar people don't
understand what the webinar is it's actually a great way to get some
access to health care that you're just not going to get any other way
you actually get the lab tests yourself for at a local lab a Quest lab near you
for the inflammation panel and the OGTT and the insulin survey these are things
inflammation and prediabetes that your doctor just
does not know about and here's the thing Harvard Health and
many others have said look sudden death is not always so sudden the
Hollywood picture that it's a bolt out of the blue is
not realistic it's more like real lightning preceded by clouds wind and
rain stop that metabolic storm before the
lightning strikes and here's where that metabolic storm
comes from it's inflammation and it has to do
usually with prediabetes so again we actually get labs
we go over them in the webinar and then you can start finding out
how you can prevent that heart attack others said
that you couldn't even predict we can show you how
thanks