Is Fish Oil Safe to Take with Cholesterol Medicines?

Tags: Anxiety, Atherosclerosis, Cholesterol, Citrus, Fish Oil, Inflammation, Omega-3 Fatty Acids, Triglycerides

Yes, it’s safe to take fish oil with Cholesterol medicines, but the question requires more than a yes or no answer.

Cholesterol and lipid-lowering medications tend to trigger anxiety in patients. Also, cholesterol medications, especially the “statin” type, have a number of reported side-effects, including damage to the liver.  The statin family includes: Crestor (rosuvastatin), Lipitor (atorvastatin), Zocor (simvastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Lescol (Novartis). Other lipid lowering agents that are not statins but work to treat elevated cholesterol and triglycerides levels include Zetia (ezetimibe), Lopid (gemfibrozil), Tricor (fenofibrate), niacin containing pharmaceuticals like Niaspan, and bile acid sequestrants like Questran (cholestyramine) and Colestid (colestipol).

The way physicians look at cholesterol is by using a fasting lipid profile, which gives a patient’s level of total cholesterol and the levels of LDL, HDL and triglycerides. Lowering LDL (“bad cholesterol”), raising HDL (“good cholesterol”), and lowering triglycerides (fat in the blood), have all been associated with lowering the risk of heart disease and atherosclerosis (hardening of the arteries). Each of the above listed medications can improve the lipid profile.

Typically, when the decision to start a cholesterol medication is made, the physician and patient discuss the risk of atherosclerosis and decide that preventing heart disease, stroke, and peripheral vascular disease is worth this possible risk.  Most patients do well with these medications, but some experience side effects.

Side effects from cholesterol medications are always a concern for physicians because many medications cannot be taken along with cholesterol medications. It is always wise to alert your doctor to new medications you’re taking .

The statin group of cholesterol medications affects a certain protein in the liver that manufactures cholesterol.  Therefore,the liver attempts to remove the medication from the body and this often causes side effects.  Adding other medications to the cholesterol medication can worsen the side effects because the liver cannot remove certain chemical mixes as fast. The chemicals linger and can build up, which can lead to liver damage.

Fish Oil and Cholesterol Medicines — The Facts

Omega-3 fatty acids are not metabolized by the liver and are easily absorbed and used by the body.  If a patient is tolerating a cholesterol medicine, there is no reason to avoid fish, fish oil, or an omega-3 fatty acid supplement.  A 2000 study by the University Department of Medicine at the Manchester Royal Infirmary in the United Kingdom observed that giving omega-3 supplements to patients already taking the statin, simvastatin, was not only safe, but lowered triglycerides further than achieved with the simvastatin alone.

You should still let your physician know if you are taking fish oil or omega-3 supplements so that he/she will be able to accurately assess your lipid profile. Omega-3 fatty acids have been shown to help lower triglycerides and raise HDL but they can also increase the LDL, the “bad” cholesterol.  Since LDL is the main risk factor for developing heart disease, doctors keep a close eye on this number.

Many people ask if they should continue taking an omega-3 supplement if they are on a cholesterol medicine and their lipid profile is good. Remember, omega-3 fatty acids have many beneficial effects on health. Omega-3 fatty acids lower inflammation, improve cell membrane functioning and help the nervous system. Furthermore, heart disease and atherosclerosis is more than just high cholesterol;  Inflammation is also a large part of the development of plaques on artery walls.

A study presented at the 2005 American Heart Association Scientific Sessions by Dr. Mitsuhiro Yokoyama at the Kobe University Graduate School of Medicine in Japan looked at 18,000 individuals with a history of heart disease who took the statin drugs Zocor or Pravachol. Individuals who took high doses of an omega-3 fatty acid with the statin were 19 percent less likely to have major coronary events (i.e. heart attack), compared with those who took statins alone. The dosage of omega-3 used in the study was about ten times the dose found in a typical omega-3 supplement, and these were high-risk individuals with a history of heart disease.

Further research needs to be done on the safety and appropriate dosage of omega-3 supplementation in healthy individuals.  However, it seems that omega-3 has a benefit beyond what cholesterol medications provide. At this time, ensuring adequate fish intake and the addition of an omega-3 supplement is a safe complement to a cholesterol treatment plan prescribed by your physician.

Key Points to Remember

1.    If you are safely taking a cholesterol medicine, adding a fish oil or Omega-3 fatty acid is safe.
2.    Let your physician know if you are taking a fish oil or Omega-3 fatty acid supplement.
3.    Atherosclerosis, heart disease, strokes, and peripheral vascular disease develop as a consequence of high cholesterol and inflammation. Omega-3 fatty acids affect lipids/cholesterol and inflammation.
4.    A combination of an omega-3 fatty acid supplement with a statin cholesterol medication seems to provide heart benefit beyond the benefit of the statin alone.

Sources
University Department of Medicine at the Manchester Royal Infirmary
2005 American Heart Association Scientific Sessions