Fish oil supplements do not prevent heart attacks or strokes in patients with diabetes, according to recent study results from the ASCEND (A Study of Cardiovascular Events in Diabetes) trial presented in a Hot Line Session at ESC Congress 2018 and published in the New England Journal of Medicine.
The ASCEND trial examined whether fish oil supplements reduce the risk of a cardiovascular event in patients with diabetes.
In observational studies, higher consumption of fish is associated with lower risks of coronary artery disease and stroke. However, previous trials have not been able to show that taking fish oil supplements containing omega-3 fatty acids reduce the risk of having cardiovascular events.
During an average of 7.4 years of follow-up, a first serious vascular event occurred in 689 (8.9%) participants allocated fish oil supplements and 712 (9.2%) participants allocated placebo.
There was no significant difference between the two groups.
The primary efficacy outcome was the first serious vascular event, which included non-fatal heart attacks, non-fatal strokes or transient ischemic attacks (sometimes called “mini-strokes”), or deaths from a cardiovascular cause.
Principal investigator, Dr. Louise Bowman, said, “Our large, long-term randomised trial shows that fish oil supplements do not reduce the risk of cardiovascular events in patients with diabetes.
This is a disappointing finding, but it is in line with previous randomised trials in other types of patient at increased risk of cardiovascular events which also showed no benefit of fish oil supplements.”
“There is no justification for recommending fish oil supplements to protect against cardiovascular events,” he added.
Suicide can’t be predicted by asking about suicidal thoughts : Study
Most people who died of suicide deny they experience suicidal thoughts when asked by doctors in the weeks and months leading up to their death, a major Australian study has found.
The findings, co-authored by clinical psychiatrist and Professor Matthew Large from UNSW’s School of Psychiatry, Sydney that published in the journal BJPsych Open The meta-analysis challenge the widely-held assumption that psychiatrists can predict who will suicide by asking if they are preoccupied with thoughts of killing themselves.
The study showed that 80% of patients who were not undergoing psychiatric treatment and who died of suicide reported not to have suicidal thoughts when asked by their psychiatrist or GP.
“If you meet someone who has suicidal ideation there is a 98 per cent chance that they are not going to suicide,” said Professor Large, an international expert on suicide risk assessment who also works in the emergency department of a major Sydney hospital.
“But what we didn’t know was how frequently people who go on to suicide have denied having suicidal thoughts when asked directly,” he added.
“This study proves we can no longer ration psychiatric care based on the presence of suicidal thoughts alone. We need to provide high-quality, patient-centred care for everyone experiencing mental illness, whether or not they reveal they are experiencing suicidal thoughts,” Professor Large said.
About one in 10 people will have suicidal ideation in their lifetime. But the study showed suicidal ideation alone was not rational grounds for deciding who gets treatment and who does not, Professor Large said.
“We know that suicide feeling is pretty common and that suicide is actually a rare event, even among people with severe mental illness,” Professor Large added.
Suicidal ideation tells us an awful lot about how a person is feeling, their psychological distress, sometimes their diagnosis and their need for treatment but it’s not a meaningful test of future behaviour.
Suicidal feelings can fluctuate rapidly and people may suicide very impulsively after only a short period of suicidal thoughts.
But, people had good reasons not to disclose thoughts of suicide, fearing stigma, triggering over-reactions or upsetting family and friends, and being involuntarily admitted for psychiatric treatment, Professor Large said.
Professor Large emphasized that clinicians should not assume that patients experiencing mental distress without reporting suicidal ideas were not at elevated risk of suicide.