Dr. Roach: Very high triglycerides may need a step up from OTC fish oil
Dear Dr. Roach: I recently saw an ad on TV for Vascepa. It seems to be a drug for lowering triglycerides. I did some additional research and found that it also works as an anti-inflammatory. My triglycerides on my last bloodwork were 160. Would this drug be of benefit for me? Some say it’s merely fish oil, which I have taken for several years. I wonder if it’s just a higher octane of fish oil, so to speak.
Dear B.: Before taking a medication, it should be very clear what the goals of the medication are. This is true whether the medicine is prescription, over-the-counter, vitamin or other supplement.
In the case of people with high triglycerides, the goal of omega-3 fish oil is preventive. For people with VERY high triglycerides (over 885 mg/dL), reducing triglycerides reduces the incidence of inflammation of the pancreas. That is not a concern for you; in your case, the goal is to reduce the likelihood of having a heart attack or stroke.
Vascepa is a highly purified omega-3 fish oil ester. It was shown in a study to reduce risk of the combination of cardiac death, heart attack and stroke in people with elevated triglyceride levels (135-500) AND a history of coronary artery disease OR diabetes and an additional risk factor such as high blood pressure, evidence of blood inflammation or peripheral artery disease. In this group of high-risk subjects, Vascepa reduced the risk of developing one of the endpoints from 22% to 17%. All subjects in the study were also taking a statin.
If you are considering taking a fish oil supplement because you are at higher risk for heart disease or stroke, a statin drug is a much better studied mechanism to reduce that risk. If your triglycerides remain elevated despite statin therapy, then Vascepa is a good idea if you fall into a high-risk group. I would recommend Vascepa, in this instance, rather than an over-the-counter fish oil supplement, due to the good-quality evidence of benefit and the concern that some brands of OTC supplements are not of excellent quality.
Eating fatty fish, such as salmon, one or two servings a week gives many of the benefits of fish oil supplementation.
Dear Dr. Roach: My husband is 55 years old. He was in the hospital about a year ago for a mild heart attack. At the time, a urine test was performed and a small amount of blood was detected in his urine. He went through the usual tests and scans, including a CT scan and cystoscopy, but nothing could be found to indicate the reason for the blood. A year later, his urine still tests positive for blood. The doctor doesn’t seem overly concerned. but I’d like to know what is causing the blood in his urine. Is it acceptable to live with a small amount of blood in the urine?
Dear M.H.: Small amounts of blood in the urine are extremely common. There are many causes, the most are concerning of which is bladder cancer. It is more common in men over 35 or those with certain occupational exposures. Concern for bladder cancer is the main reason why your husband had the CT scan and cystoscopy.
If kidney function is normal and stable, there is no protein in the urine and the CT scan and cystoscopy are normal, then no further workup is usually recommended. Yearly repeat followup visits are recommended. No cause is usually ever identified in such cases.
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