The National Institute for Health and Clinical Excellence has, for the first time, recommended a number of ‘lifestyle’ changes alongside prescription medicines for patients at risk of a second heart attack.

In its guidelines, NICE says doctors should advise patients to: eat a Mediterranean-style diet (more bread, fruit, vegetables and fish, less meat, and replacing butter and cheese with products based on vegetable and plant oils) with sufficient levels of the fatty acid omega-3; quit smoking; and exercise for 20-30 minutes a day.

Largely because of a lack of evidence, previous guidance, issued six years ago, offered no such recommendations, and the Institute hopes that this fresh approach will play a big hand in reducing premature deaths by “improving the care received by hundreds of thousands of adults in England and Wales who have survived a heart attack.”

Clinical evidence to support the role of omega-3 fatty acids in heart health has been mounting, and the Institute recommends that patients consume at least 7g from two to four portions of oily fish per week. For those failing to reach this target through their diet, doctors should consider providing an omega-3 supplement, such as Solvay's Omacor, for up to four years.

Are supplements cost effective?

Clearly, the most cost-effective means for patients to obtain omega-3 fatty acids is from dietary sources but, if this is not possible, then provision of supplements does appear to be a cost effective use of NHS resources, NICE claims. A spokesman for the Institute told PharmaTimes UK News that, in the first year, the cost to the NHS of prescribing supplementation is expected to be around £7 million, but that implementing the guidance overall will save the Service nearly £6 million.

To put this in perspective, a study last year put the annual cost of heart disease to the UK economy at a whopping £29 billion. According to Oxford University's Health Economics Research Centre, the total cost of heart disease to the NHS hit £16 billion in 2004, with 69 million working days as a result.

'Invaluable' guidance

Professor Mayur Lakhani, chairman of the Royal College of General Practitioners, said: “Having a heart attack used to be a life sentence for patients, now it is possible for most patients to lead healthy and fulfilling lives. This requires a high standard of modern medical care and for patients to follow lifestyle advice - which is why this clear and comprehensive guidance is so important and why practising GPs like myself, together with practice nurses, find documents like this invaluable.”

But commenting on the recommendations, the British Heart Foundation told PharmaTimes UK News that “omega-3 supplements should not replace fresh fish for heart patients.” And in a statement, Ellen Mason, Cardiac Nurse at the BHF, added: “it is more nutritious to eat fish than swallowing a capsule,” and warned: “Fish oil supplements can adversely interact with medications including warfarin, aspirin and clopidogrel and should only be taken after discussion with [a] doctor.”