congestive heart failure Archives - Health Tips From The Professor

Is Melatonin Safe?

February 3, 2026 by Dr. Steve Chaney

What Is Peer Review?

Author: Dr. Stephen Chaney

Recent headlines claim that long-term melatonin use may be risky. Specifically, the headlines claim that long term melatonin use may increase the risk of:

Heart failure by 90%.

Hospitalization for heart failure by almost 3.5-fold.

All-cause mortality by 2-fold.

Those statistics are frightening. But as Mark Twain said, “There are lies. There are damn lies, and then there are statistics.”

So, as someone who uses a melatonin supplement regularly, the claims about heart failure risk made me want to check out the study behind the headlines.

I set out to answer two questions:

Are the claims about melatonin use and heart failure risk true?

Are they significant?

How Was The Study Done?

Here is what we know about the study:

The authors used a global data network of healthcare providers called the TriNetX Global Research Network and selected all patient records in the network of adults >18 who had a clinical diagnosis of insomnia.

They compared insomnia patients that had been prescribed melatonin for at least a year with non-melatonin users. Patients on heart failure drugs were excluded from the analysis.

Outcomes (new diagnosis of heart failure, hospitalization for heart failure, and all-cause mortality) were assessed 5 years after the patients were first prescribed melatonin.

A small subset of the two groups (414 in each group) were compared with respect to things like:

- Demographics (things like age, sex, socioeconomic status, and income level).

- Other diagnosed diseases.

- Other medication use.

- Healthcare utilization.

- Blood and urine lab results.

- Vitals (things like weight, height, blood pressure, heart rate, etc.

I said, “Here is what we know about the study” because this was not a published clinical study. It was a poster presented at a scientific meeting.

That means that a lot of details about design of the experiments and how the data were analyzed are missing. It also means the study has not gone through the peer review process that is required for publication in a scientific journal.

To help you understand why that is important, let me explain the peer review process.

What Is Peer Review?

Poster presentations at scientific meetings, like this one, have a couple of purposes:

They give graduate students and post-doctorate fellows a chance to learn how to present and defend their research. It also gives them a chance to form relationships with the leaders in their field who may become their next step up the career ladder.

They foster discussions with other experts in the field who may spot flaws or offer helpful suggestions for improving the research before submitting it for publication.

The ultimate goal, of course, is to get the research to the point where it is ready to be submitted to a high-quality, peer-reviewed scientific journal (It is still “publish or perish” in the academic world).

This is an area in which I have extensive experience, having published over 100 articles in peer reviewed journals during my career at the University of North Carolina. I was also a reviewer for hundreds of articles during my time at UNC.

Once the manuscript has been submitted to a peer-reviewed scientific journal, they send it to two or three peers (other experts in the same area of research). Some of the peers are your friends. Others are your competitors. In either case, their goal is to make sure the paper adheres to the highest scientific standards. They review the paper for:

Hypothesis to be tested: They ask, “Is the hypothesis credible and clearly stated?”

Experimental Design: They ask, “Are the experiments designed in such a way that they adequately test the hypothesis?”

Data Collection: They ask, “Was enough data gathered to test the hypothesis?” and “Were there gaps in the data that need to be filled?”

Statistical Analysis: They ask, “Was the statistical analysis of the data sufficient to test the hypothesis?” and “Were there any important controls missing from the data collected or the statistical analysis?”

Conclusions: They ask, “Are the conclusions of the authors adequately supported by the data collected and the statistical analysis?”

If the reviewers find defects in any of these areas, they have 3 options. They can:

Ask the authors to rewrite and resubmit the manuscript.

Ask the authors to perform additional experiments or use a more rigorous statistical method before resubmitting the manuscript.

Reject the manuscript.

Hopefully, this description helps you understand the power of the peer review process and why the lack of peer review for this study is significant.

I am not saying the claims in this poster presentation are inaccurate. I’m saying the headlines about them may be premature because the study has yet to be peer-reviewed.

What Did This Study Show?

The abstract said that long-term (≥1 year) melatonin users had:

An 89% higher risk of developing heart failure.

A 3.44-fold higher risk of hospitalization for heart failure.

A 2.09-fold higher risk of all-cause mortality.

The authors concluded, “In a large, multinational real-world cohort rigorously matched on >40 baseline variables, long-term melatonin supplementation in insomnia was associated with an 89% higher hazard of incident heart failure, a three-fold increase in heart failure–related hospitalizations, and a doubling of all-cause mortality over 5 years. These findings challenge the perception of melatonin as a benign chronic therapy and underscore the need for randomized trials to clarify its cardiovascular safety profile.”

Is Melatonin Safe?

At the beginning of this article I said I wanted to answer two questions:

Are the claims about melatonin use and heart failure risk true?

Are they significant?

The first question (Are the claims about melatonin use and heart failure risk true?) is difficult to answer.

This is an abstract instead of a publication. That means I have no access to the data, statistical methods, and controls that went into the Author’s conclusions. So, I have no basis for analyzing the accuracy of the authors’ statements.

This has not gone through peer review. The conclusions of the authors may be modified or may be rejected based on peer review.

There are several questions I and others who have discussed this study would like to see answered. For example:

How can hospitalizations for heart failure be greater than the number of people with heart failure? Normally, between 20-80% (average = 45%) of people with congestive heart failure end up in the hospital. The discrepancy between hospitalizations and heart failure patients in this study suggests that:

- Some hospitalizations were for another reason and were mischaracterized as being due to heart failure…or…

- The same individual(s) were hospitalized multiple times during the 5-year follow-up.

- In either case hospitalizations for heart failure would be overcounted.

How did they accurately distinguish between melatonin users and non-users since their study drew on data from both England and the United States?

- In England, melatonin is only available by prescription, so the distinction is clear.

- But in the United States a prescription is not required. Melatonin is infrequently prescribed. Most melatonin users obtain their melatonin over the counter and are not recorded in any database.

Were the controls sufficient?

- The author’s conclusion states the data were “…matched on >40 baseline variables…”, but the Methods section states that only a small subset (414) of melatonin users were matched for those variables. That is less than 5% of the melatonin users in the study.

Are the data on the relationship between melatonin use and all-cause mortality accurate?

- Again, the increase in all-cause mortality was greater than the number of melatonin users.

- That suggests that the increase in all-cause mortality may be due to some characteristics of severe insomniacs who choose to take melatonin rather than to melatonin itself.

These are the kinds of questions that need to be answered during the peer review process and might alter the conclusions or prevent the study from being published.

So, the answer to the first question (Are the claims about melatonin use and heart failure risk true?) is, “We don’t know. The study has not gone through the peer review process and is unpublished.

Relative Risk Versus Absolute Risk

The answer to the second question (Are the claims about melatonin use and heart failure risk significant) is much clearer. It has to do with the difference between relative risk and absolute risk.

Simply put:

Relative risk is the change in risk caused by an intervention (melatonin in this case) relative to the risk without the intervention.

- Relative risk is generally used in describing the results of clinical studies because it gives much larger numbers and is, therefore, more newsworthy. It is more likely to generate the headlines you see and grab your attention.

Absolute risk is the actual change in risk that you experience.

- This is the risk that matters to you.

With those simple definitions, let’s review the claims of this study:

The study said that long-term melatonin use increased the risk of heart failure by 90%. That sounds horrible, but it is an increase in relative risk!

- To calculate the absolute increase in the risk of heart failure, you need to first ask what the baseline risk is in non-melatonin users. In this study it was 2.7%.

- With that information, we can do some simple math. A 90% increase would increase the risk to 4.6%. 4.6% – 2.7% = 1.9%.

- That means the absolute increase in risk caused by long-term melatonin use is less than 2%.

The study said that long-term melatonin use increases the risk of hospitalization 3.44-fold.

- On average, 45% of heart failure patients are hospitalized. Since the risk of heart failure in this study was 2.7%, that means the baseline for hospitalization should be 45% of 2.7% or around 1.2%.

- A 3.44-fold increase would increase that to 4.2% which means that the absolute risk of being hospitalized if you are a heart failure patient is around 3% (4.2% – 1,2%).

Finally, if the increase in all-cause mortality is solely caused by melatonin use (which is unclear), melatonin use increases mortality risk from 4.3% to 7.8%, for an absolute increase in risk of 3.5%.

In short, if the claims about melatonin use and heart failure are true (which is uncertain) the absolute increase in risk is very small for the average, healthy adult.

What Does This Study Mean For You?

If you are an average, healthy adult you probably do not need to be concerned about the headlines linking melatonin use with heart failure.

It is not yet clear whether the claims are accurate.

And, if they are accurate, your increased risk is very small.

There are, however, some caveats.

If you suffer from severe, chronic insomnia you should consult your healthcare provider first.

- Your insomnia may be caused by an underlying health condition.

- Your healthcare provider may suggest more effective treatments. Some of these treatments may have more side effects than melatonin use, but it always useful to know what your choices are.

If you have been diagnosed with heart failure, you should avoid melatonin.

Finally, even though this study is very preliminary, there are also some individuals who may wish to consult with their healthcare provider before taking melatonin. These include people with conditions that increase the risk of heart failure such as coronary heart disease, heart attacks, diabetes, obesity, and high blood pressure.

The Bottom Line

Recent headlines have suggested that long-term melatonin use substantially increases the risk of heart failure, hospitalizations due to heart failure, and premature death.

However, these headlines were based on an abstract of a poster presented at a scientific meeting. That means:

There is not adequate information available to analyze the data behind the claims.

The study has not yet gone through the peer review process, so we don’t know whether the claims are accurate.

Based on my evaluation of the available information, my analysis is:

If you are an average, healthy adult you probably do not need to be concerned about the headlines linking melatonin use with heart failure.

It is not yet clear whether the claims are accurate.

And, if they are accurate, your increased risk is actually very small.

For more information on the study and who should consult with their healthcare provider before using melatonin, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

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About The Author

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 54 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Which Supplements Are Good For Your Heart?

February 7, 2023 by Dr. Steve Chaney

How Should You Interpret This Study?

Author: Dr. Stephen Chaney

February is Heart Health month. So, it is fitting that we ask, “What is the status of heart health in this country?” The American Heart Association just published an update of heart health statistics through 2019 (CW Tsao et al, Circulation, 145: e153-e639, 2022). And the statistics aren’t encouraging. [Note: The American Heart Association only reported statistics through 2019 because the COVID-19 pandemic significantly skewed the statistics in 2020 and 2021].

The Good News is that between 2009 and 2019:

All heart disease deaths have decreased by 25%.
Heart attack deaths have decreased by 6.6%.
Stroke deaths have decreased by 6%.

The Bad News is that:

Heart disease is still the leading cause of death in this country.
Someone dies from a heart attack every 40 seconds.
Someone dies from a stroke every 3 minutes.

Diet, exercise, and weight control play a major role in reducing the risk of heart disease. Best of all, they have no side effects. They represent a risk-free approach that each of us can control.

But is there something else? Could supplements play a role? Are supplements hype or hope for a healthy heart?

All the Dr. Strangeloves in the nutrition space have their favorite heart health supplements. They claim their supplements will single-handedly abolish heart disease (and help you leap tall buildings in a single bound).

On the other hand, many doctors will tell you these supplements are a waste of money. They don’t work. They just drain your wallet.

It’s so confusing. Who should you believe? Fortunately, a recent study (P An et al, Journal of the American College of Cardiology, 80: 2269-2285, 2022) has separated the hype from the hope and tells us which “heart-healthy” supplements work, and which don’t.

How Was This Study Done?

This was a major clinical study carried out by researchers from the China Agricultural University and Brown University in the US. It was a meta-analysis, which means it combined the data from many published clinical trials.

The investigators searched three major databases of clinical trials to identify:

884 randomized, placebo-controlled clinical studies…

Of 27 types of micronutrients…

With a total of 883,627 patients…

Looking at the effectiveness of micronutrient supplementation lasting an average of 3 years on either…

- Cardiovascular risk factors like blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides…or…

- Cardiovascular outcomes such as coronary heart disease (CHD), heart attacks, strokes, and deaths due to cardiovascular disease (CVD) and all causes.

[Note: Coronary heart disease (CHD) refers to build up of plaque in the coronary arteries (the arteries leading to the heart). It is often referred to as heart disease and can lead to heart attacks (myocardial infarction). Cardiovascular disease (CVD) is a more inclusive term that includes coronary heart disease, stroke, congenital heart defects, and peripheral artery disease.]

The investigators also included an analysis of the quality of the data in each of the clinical studies and rated the evidence of each of their findings as high quality, moderate quality, or low quality.

Which Supplements Are Good For Your Heart?

The top 3 heart-healthy supplements in this study were:

Omega-3 Fatty Acids:

Increased HDL cholesterol and decreased triglycerides, both favorable risk factors for heart health.
Deceased risk of heart attacks by 15%, all CHD events by 14%, and CVD deaths by 7% (see definitions of CHD and CVD above).
The median dose of omega-3 fatty acids in these studies was 1.8 g/day.
The evidence was moderate quality for all these findings.

Folic Acid:

Decreased LDL cholesterol (moderate quality evidence) and decreased blood pressure and total cholesterol (low quality evidence).
Decreased stroke risk by 16% (moderate quality evidence).

Coenzyme Q10:

Decreased triglycerides (high quality evidence) and reduced blood pressure (low quality evidence).
Decreased the risk of all-cause mortality by 32% (moderate quality evidence).
These studies were performed with patients diagnosed with heart failure. Coenzyme Q10 is often recommended for these patients, so the studies were likely performed to test the efficacy of this treatment.

There were three micronutrients (vitamin C, vitamin E, and vitamin D) that did not appear to affect heart disease outcomes.

Finally, as reported in previous studies, β-carotene increased the risk of stroke, CVD mortality, and all-cause mortality.

In terms of the question I asked at the beginning of this article, this study concluded that:

Omega-3, folic acid, and coenzyme Q10 supplements represent hope for a healthy heart.
Vitamin C, vitamin E, and vitamin D supplements represent hype for a healthy heart.
β-carotene supplements represent danger for a healthy heart.

But these conclusions just scratch the surface. To put them into perspective we need to dig a bit deeper.

How Should You Interpret This Study?

In evaluating the significance of these findings there are two things to keep in mind.

#1: This study is a meta-analysis and meta-analyses have both strengths and weaknesses.

The strength of meta-analyses is that by combining multiple clinical studies they can end up with a database containing 100s of thousands of subjects. This allows them to do two things:

It allows the meta-analysis to detect statistically significant effects that might be too small to detect in an individual study.
It allows the meta-analysis to detect the average effect of all the clinical studies it includes.

The weakness of meta-analyses is that the design of individual studies included in the analysis varies greatly. The individual studies vary in things like dose, duration, type of subjects included in the study, and much more.

This is why this study rated most of their conclusions as backed by moderate- or low-quality evidence. [Note: The fact that the authors evaluated the quality of evidence is a strength of this study. Most meta-analyses just report their conclusions without telling you how strong the evidence behind those conclusions is.]

#2: Most clinical studies of supplements (including those included in this meta-analysis) have two significant weaknesses.

Most studies do not measure the nutritional status of their subjects prior to adding the supplement. If their nutritional status for a particular nutrient was already optimal, there is no reason to expect more of that nutrient to provide any benefit.
Most studies measure the effect of a supplement on a cross-section of the population without asking who would be most likely to benefit.

You would almost never design a clinical study that way if you were evaluating the effectiveness of a potential drug. So, why would you design clinical studies of supplements that way?

With these considerations in mind, let me provide some perspective on the conclusions of this study.

Coenzyme Q10:

This meta-analysis found that coenzyme Q10 significantly reduced all-cause mortality in patients with heart failure. This is consistent with multiple clinical studies and a recent Cochrane Collaboration review.

Does coenzyme Q10 have any heart health benefits for people without congestive heart failure? There is no direct evidence that it does, but let me offer an analogy with statin drugs.

Statin drugs are very effective at reducing heart attacks in high-risk patients. But they have no detectable effect on heart attacks in low-risk patients. However, this has not stopped the medical profession from recommending statins for millions of low-risk patients. The rationale is that if they are so clearly beneficial in high-risk patients, they are “probably” beneficial in low-risk patients.

I would argue a similar rationale should apply to supplements like coenzyme Q10.

Omega-3s:

This study found that omega-3 reduced both heart attacks and the risk of dying from heart disease. Most previous meta-analyses of omega-3s and heart disease have come to the same conclusion. However, some meta-analyses have failed to find any heart health benefits of omega-3s. Unfortunately, this has allowed both proponents and opponents of omega-3 use for heart health to quote studies supporting their viewpoint.

However, there is one meta-analysis that stands out from all the others. A group of 17 scientists from across the globe collaborated in developing a “best practices” experimental design protocol for assessing the effect of omega-3 supplementation on heart health. They conducted their clinical studies independently, and when their data (from 42,000 subjects) were pooled, the results showed that omega-3 supplementation decreased:

Premature death from all causes by 16%.
Premature death from heart disease by 19%.
Premature death from cancer by 15%.
Premature death from causes other than heart disease and cancer by 18%.

This study eliminates the limitations of previous meta-analyses. That makes it much stronger than the other meta-analyses. And these results are consistent with the current meta-analysis.

Omega-3s have long been recognized as essential nutrients. It is past time to set Daily Value (DV) recommendations for omega-3s. Based on the recommendations of other experts in the field, I think the DV should be set at 500-1,000 mg/day. I take more than that, but this would represent a good minimum recommendation for heart health.

Folic acid:

As with omega-3s, this meta-analysis reported a positive effect of folic acid on heart health. But many other studies have come up empty. Why is that?

It may be because, between food fortification and multivitamin use, many Americans already have sufficient blood levels of folic acid. For example, one study reported that 70% of the subjects in their study had optimal levels of folates in their blood. And that study also reported:

Subjects with adequate levels of folates in their blood received no additional benefit from folic acid supplementation.
However, for subjects with inadequate blood folate levels, folic acid supplementation decreased their risk of heart disease by ~15%.

We see this pattern over and over in supplement studies. Supplement opponents interpret these studies as showing that supplements are worthless. But a better interpretation is that supplements benefit those who need them.

The problem is that we don’t know our blood levels of essential nutrients. We don’t know which nutrients we need, and which we don’t. That’s why I like to think of supplements as “insurance” against the effects of an imperfect diet.

Vitamins E and D:

The situation with vitamins E and D is similar. This meta-analysis found no heart health benefit of either vitamin E or D. That is because the clinical studies included in the meta-analysis asked whether vitamin E or vitamin D improved heart health for everyone in the study.

Previous studies focusing on patients with low blood levels of these nutrients and/or at high risk of heart disease have shown some benefits of both vitamins at reducing heart disease risk.

So, for folic acid, vitamin E, and vitamin D (and possibly vitamin C) the take-home message should be:

Ignore all the Dr. Strangeloves telling you that these vitamins are “magic bullets” that will dramatically reduce your risk of heart disease.
Ignore the naysayers who tell you they are worthless.
Use supplementation wisely to make sure you have the recommended intake of these and other essential nutrients.

β-carotene:

This meta-analysis reported that β-carotene increased the risk of heart disease. This is not a new finding. Multiple previous studies have come to the same conclusion.

And we know why this is. There are many naturally occurring carotenoids, and they each have unique heart health benefits. A high dose β-carotene supplement interferes with the absorption of the other carotenoids. You are creating a deficiency of other heart-healthy carotenoids.

If you are not getting lots of colorful fruits and vegetables from your diet, my recommendation is to choose a supplement with all the naturally occurring carotenoids in balance – not a pure β-carotene supplement.

The Bottom Line

The Dr. Strangeloves in the nutrition space all have their favorite heart health supplements. They claim their supplements will single-handedly abolish heart disease (and help you leap tall buildings in a single bound).

On the other hand, many doctors will tell you these supplements are a waste of money. They don’t work. They just drain your wallet.

It’s so confusing. Who should you believe? Fortunately, a recent study has separated the hype from the hope and tells us which “heart-healthy” supplements work, and which don’t.

This study was a meta-analysis of 884 clinical studies with 883,627 participants. It reported:

Omega-3 supplementation deceased risk of heart attacks by 15% and all cardiovascular deaths by 7%.
Folic acid supplementation decreased stroke risk by 16%.
Coenzyme Q10 supplementation decreased the risk of all-cause mortality in patients with heart failure by 32%.
Vitamin C, vitamin E, vitamin D did not appear to affect heart disease outcomes.
β-carotene increased the risk of stroke, CVD mortality, and all-cause mortality.

For more details on this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Omega-3s And Congestive Heart Failure

May 3, 2022 by Dr. Steve Chaney

We Have Been Asking The Wrong Questions

Author: Dr. Stephen Chaney

Today’s Health Tip is a follow-up to the article I published last month on omega-3s and heart disease risk. In that article I pointed out the reasons why studies of the effect of omega-3s and heart disease risk have been so confusing.

One of the reasons is that many of the studies have been asking the wrong questions.

They were asking whether omega-3s reduced the risk of heart disease for everyone. Instead, they should have been asking who benefited from omega-3 supplementation.

They were asking whether omega-3s reduced the risk of all forms of heart disease combined. Instead, they should have been asking whether omega-3s reduced the risk of specific kinds of heart disease.

I also discussed a large clinical trial, the VITAL study, that was designed to answer those two questions.

The study I will describe today (L Djoussé et al, JACC Heart Failure, 10: 227-234, 2022) mined the data from the VITAL study to evaluate the effect of omega-3 supplementation on congestive heart failure, a form of heart disease that was not discussed in the VITAL study.

Everything You Need To Know About Congestive Heart Failure

Congestive heart failure is a killer. The term congestive heart failure simply means that your heart no longer pumps blood well. The initial symptoms are relatively non-specific and include things like.

Shortness of breath.
Fatigue and weakness.
Reduced ability to exercise.
Rapid or irregular heartbeat.
Persistent cough or wheezing.

However, as it progresses, the symptoms get much worse. Fluid builds up in your tissues.

Fluid buildup in your legs, ankles, and feet can make it difficult to walk.

Fluid buildup in your lungs makes it difficult to breathe. In advanced stages it can feel like you are drowning in a room full of air.

According to the CDC:

4 million Americans have congestive heart failure (CHF).

- It leads to ~380,000 deaths/year.

83% of patients diagnosed with CHF will be hospitalized at least once.

- 67% will be hospitalized two or more times.

CHF costs >$30 billion per year in health care costs and lost wages.

The risk of congestive heart failure is not spread evenly across the American population. Black Americans and Americans with type 2 diabetes are at increased risk.

According to the Framingham Heart Study:

Type 2 diabetes increases the risk of CHF 2-fold in men and 5-fold in women. The reasons are not entirely clear. However:

- High blood sugar is thought to either damage cells in heart muscle, weakening it, or damage small blood vessels within the heart, making it more difficult for the heart to pump blood.

- Some diabetes drugs that lower blood sugar also appear to increase the risk of congestive heart failure.

According to the CDC:

Black Americans are 2-fold more likely to develop CHF than White Americans. Again, the reasons are not clear. However:

- Some experts feel it could be due to the higher incidence of untreated high blood pressure in Black Americans.

In summary:

Congestive heart failure is a serious disease. Its symptoms affect your quality of life, and it can lead to hospitalizations and death.

Black Americans and Americans with type 2 diabetes are at higher risk of developing congestive heart failure.

How Was The Study Done?

The VITAL study, from which these data were extracted, was a placebo-controlled clinical trial designed to measure the effects of 1,000 mg omega-3 supplementation on the risk of developing heart disease. It enrolled 25,871 Americans aged 55 years or older and followed them for an average of 5.3 years.

The participants enrolled in the VITAL study represented a cross-section of the American population. Most were at low risk of heart disease, but there were subsets of the study group who were at higher risk of heart disease. A strength of the VITAL study was that it was designed so the high-risk subgroups could be evaluated separately.

The current study utilized data from the VITAL study to look at the effect of omega-3 supplementation on hospitalizations due to congestive heart failure. It also evaluated the effect of type 2 diabetes and race on the risk of hospitalizations.

Omega-3s And Congestive Heart Failure

When the investigators looked at the whole population, most of whom were at low-risk of congestive heart failure, they did not see any effect of omega-3 supplementation on the risk of hospitalizations due to congestive heart failure.

However, when they looked at high risk groups, the story was much different.

In patients with type-2 diabetes:

Omega-3 supplementation reduced the risk of the initial hospitalization for congestive heart failure by 31%

Omega-3 supplementation reduced the risk of multiple hospitalizations due to congestive heart failure by 47%.

The effect of omega-3 supplementation on hospitalizations was greatest for the Black participants in the study.

In the words of the authors, “Our data show beneficial effects of omega-3 fatty acid supplements on the incidence of heart failure hospitalizations in participants with type 2 diabetes but not in those without type 2 diabetes, and such benefit appeared to be stronger in Black participants with type 2 diabetes.”

We Are Asking The Wrong Questions

As I said above, there is so much confusion about the effect of omega-3s on heart disease because we scientists have been asking the wrong questions:

We have been asking whether omega-3s reduce the risk of heart disease for everyone. Instead, we should have been asking who benefits from omega-3 supplementation.

We have been asking whether omega-3s reduced the risk of all forms of heart disease combined. Instead, we should have been asking whether omega-3s reduced the risk of specific kinds of heart disease.

In my “Health Tip” last month I discussed a large clinical study, the VITAL study, that was specifically designed to answer the right questions. Like so many other studies it found that omega-3 supplementation did not significantly reduce the risk of all kinds of heart disease for everyone.

However, what it did find was more important than what it did not find:

When they looked at the effect of omega-3s on heart disease risk in high-risk groups, they found that major cardiovascular events were reduced by:

- 26% in African Americans.

- 26% in patients with type 2 diabetes.

- 17% in patients with a family history of heart disease.

- 19% in patients with two or more risk factors of heart disease.

When they looked at the effect of omega-3s on heart disease risk in people with low omega-3 intake, they found that omega-3 supplementation reduced major cardiovascular events by:

- 19% in patients with low fish intake.

When they looked at the effect of omega-3s on the risk of different forms of heart disease, they found that omega-3 supplementation reduced:

- Heart attacks by 28% in the general population and by 70% for African Americans.

- Deaths from heart attacks by 50%.

- Deaths from coronary heart disease (primarily heart attacks and ischemic strokes (strokes caused by blood clots)) by 24%.

In other words, when they asked the wrong questions, they got the wrong answer. If they had just looked at the effect of omega-3 supplementation on all forms of heart disease for everyone (like most other omega-3 studies), they would have concluded that omega-3s are worthless.

However, when they asked the right questions, they found that omega-3s were very beneficial for high-risk populations and for certain types of heart disease.

The current study utilized the same data to analyze the effect of omega-3 supplementation on hospitalizations due to congestive heart failure. And the results were similar.

If they had asked the wrong question, “Does omega-3 supplementation reduce congestive heart failure hospitalizations for everyone?”, they would have concluded that omega-3 supplementation was worthless.

However, instead they asked, “Does omega-3 supplementation reduce congestive heart failure hospitalizations for certain high-risk groups” and were able to show that omega-3 supplementation significantly reduced congestive heart failure hospitalizations for people with type 2 diabetes and for Blacks.

We need to change the paradigm for clinical studies of supplements. The old paradigm asks the wrong questions. If we really want to know the role of supplementation for our health, we need to start asking the right questions.

The Bottom Line

There is perhaps nothing more confusing to the average person than the “truth” about omega-3 supplementation and heart disease risk. Much of the confusion is because we have been asking the wrong questions:

We have been asking whether omega-3 supplementation reduces the risk of heart disease for everyone. Instead, we should have been asking who benefits from omega-3 supplementation.

We have been asking whether omega-3 supplementation reduces the risk of all forms of heart disease combined. Instead, we should have been asking whether omega-3 supplementation reduces the risk of specific kinds of heart disease.

A recent study on the effect of omega-3 supplementation on hospitalizations due to heart disease is a perfect example.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.