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The medical community suffered three significant fish oil failures/setbacks in 2013. Claims that fish oil's EPA/DHA would stop the progression of heart disease were crushed when The Risk and Prevention Study Collaborative Group (Italy) released a conclusive negative finding regarding fish oil for those patients with high risk factors but no previous myocardial infarction. Fish oil failed in all measures of CVD prevention—both primary and secondary. Another major 2013 setback occurred when fish oil's DHA was shown to significantly increase prostate cancer in men, in particular, high-grade prostate cancer, in the Selenium and Vitamin E Cancer Prevention Trial (SELECT) analysis by Brasky et al. Another monumental failure occurred in 2013 whereby fish oil's EPA/DHA failed to improve macular degeneration. In 2010, fish oil's EPA/DHA failed to help Alzheimer's victims, even those with low DHA levels. These are by no means isolated failures. The promise of fish oil and its so-called active ingredients EPA / DHA fails time and time again in clinical trials. This lipids-based physiologic review will explain precisely why there should have never been expectation for success. This review will focus on underpublicized lipid science with a focus on physiology.

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sociation between persistence with statins and risk of incident cardiac events. The most persistent users (PDC Ͼϭ 80%) had a hazard ratio of 0.62 (95% confidence interval: 0.58-0.67) compared to non-persistent users (PDC Ͻ20%). Similar results were found when analyses were limited to patients with more than 5 years of follow up. An interaction analysis between persistence and other factors detected a stronger risk reduction among diabetic males. CONCLUSIONS: This large and unselected community-based study supports the results of several randomized controlled trials regarding the beneficial effect of persistent statin therapy against cardiac events among primary prevention patients. OBJECTIVES:Healthcare Effectiveness Data and Information Set (HEDIS) defines controlled hypertension as systolic/diastolic BP (SBP/DBP) Ͻ130/80 mm Hg for patients with essential hypertension and diabetes. We estimated the percentage of diabetes patients with uncontrolled essential hypertension who would reach SBP goals with the angiotensin II receptor blockers (ARBs) azilsartan medoxomil, valsartan, and olmesartan medoxomil. METHODS: A Monte Carlo simulation model was created to estimate the number of patients with hypertension (SBP Ն130 mm Hg) and diabetes who would achieve SBP goal when treated with azilsartan medoxomil, valsartan, or olmesartan medoxomil for 12 months. A cohort of 100,000 hypothetical diabetes patients with uncontrolled hypertension was created from NHANES 1999 -2006 and assigned a baseline SBP. Follow-up SBPs were generated by randomly sampling from the mean and SD of the percentage change from baseline to final visit in sitting office SBPs by using data from the diabetes subpopulation from the azilsartan medoxomil clinical trial program. MeanϮSD relative changes in SBP were Ϫ10.36%Ϯ10.41, Ϫ4.58%Ϯ11.04, Ϫ5.16%Ϯ11.82% (F-test PϽ.001) for azilsartan medoxomil, valsartan,and olmesartan medoxomil, using the pooled efficacies across all dosages, respectively. We assessed goal attainment assuming that adherence was alternatively perfect and that 48% of patients receiving any ARB would discontinue treatment. RESULTS: Patient characteristics based on NHANES data were meanϮSD age 56Ϯ13 years, 56% male, 23% with prior cardiovascular disease, baseline SBP 151Ϯ19 mm Hg. We estimated that 41.0% of patients receiving azilsartan medoxomil would achieve SBP goal vs. 26.8% for valsartan and 28.8% for olmesartan medoxomil, assuming perfect adherence; accounting for nonadherence, 21.2%, 13.9%, and 14.8% of patients would reach SBP goals, respectively. CONCLUSIONS: Our findings suggest that more diabetes patients treated with azilsartan medoxomil than with valsartan or olmesartan medoxomil are expected to reach SBP goal. Further analysis should address whether these differences in SBP translate into better HEDIS quality scores.