Serum Lipids In Patients Research Articles

Serum Lipids in Patients with Active Rheumatoid Arthritis And It's Relation to Drug Therapy

Serum Lipids in Patients with Active Rheumatoid Arthritis And It's Relation to Drug Therapy

Doxazosin GITS versus standard doxazosin in mild to moderate hypertension

Background The selective α 1-adrenoceptor antagonist doxazosin in both standard formulation and gastrointestinal therapeutic system (GITS) controlled-release formulation is effective for hypertension without having a negative impact on serum lipids. This study was designed to compare the relative efficacy of these two formulations of doxazosin on clinic and ambulatory blood pressure and serum lipids in patients with mild to moderate hypertension. Methods Hypertensive patients aged 18–70 years ( n=335) were evaluated in a multi-center prospective randomized study. Following a 2-week placebo run-in phase, patients were randomized to receive doxazosin 2 or 4 mg, with dose titration, or doxazosin GITS 4 mg, no dose titration, for 9 weeks. Results Both doxazosin formulations reduced clinic diastolic and systolic blood pressure from baseline ( P<0.0001). Doxazosin GITS and doxazosin 4 mg had similar blood pressure-lowering effects. Doxazosin GITS reduced sitting diastolic and systolic blood pressure compared with doxazosin 2 mg ( P<0.01 for both). A greater proportion of the doxazosin GITS group reached goal blood pressure (≤140/90 mm Hg) after 9 weeks compared with the doxazosin 2-mg group. All doses of doxazosin reduced 24-h and daytime (7:00 am to 10:00 pm) ambulatory blood pressure from baseline (all P<0.01). Doxazosin GITS significantly reduced nighttime (10:00 pm to 7:00 am) ambulatory blood pressure from baseline. A neutral effect on serum lipids was observed with doxazosin. Conclusions Doxazosin GITS and doxazosin were effective in reducing clinic and ambulatory blood pressure. The GITS formulation reduced the need for dose titration. Both doxazosin formulations were well tolerated.

웹기반 영양상담이 고지혈증 환자의 식사섭취 및 혈청 지질에 미치는 영향

본 웹기반 영양상담 프로그램은 전보(17)에서 개발된 고지혈증환자를 위한 영양상담 프로그램에 환자들의 추후관리를 위해 재진상담 프로그램을 개발하여 삽입하였다. 개발된 재진상담 프로그램은 식습관 조사, 식품섭취빈도 조사 및 온라인 상담 파일로 구성되었으며 온라인 상담 파일에 채팅룸을 두어 환자들과 실시간으로 상담할 수 있도록 하였다. 8주간의 웹을 이용한 영양상담 후 신체계측치의 변화에서 체질량지수는 고콜레스테롤혈증군과 고중성지방혈증군 모두에서 감소하였고, 허리/엉덩이 둘레비는 고콜레스테롤혈증군 중 남자에게서 유의하게 감소하였다(p<0.05). 혈청 지질의 변화는 고콜레스테롤혈증군은 총콜레스테롤과 LDL-콜레스테롤이 영양상담 후에 유의하게 감소하였고(p<0.01), 고중성지방혈증군은 중성지방이 유의하게 감소하였으며(p<0.01), HDL-콜레스테롤은 유의하게 증가하였다(p<0.05). 영양소 섭취의 변화는 두군 모두에서 영양상담 후에 에너지 섭취량이 감소하였고 특히 열량영양소 중 지방의 섭취량이 51.9~52.5 g에서 영양상담 후 32.5~33.3 g으로 유의하게 감소하였다(p<0.01). 그러나 1,000 ㎉당 영양소 섭취량을 비교하여 보면 영양상담 후 환자들은 열량은 낮으면서 영양소 밀도가 높은 식품을 선택하여 비타민 B₁과 B₂는 유사하게 섭취하였으며 비타민 C, 칼슘 및 철분은 오히려 높게 섭취하였다. 지방산 섭취의 변화는 영양상담 후 두군 모두에서 포화지방산의 섭취량이 유의하게 감소하였으며, 이로 인해 포화지방산, 단일불포화지방산, 다가불포화지방산의 섭취비율이 고지혈증 치료지침의 권장비율에 속하였다. 콜레스테롤 섭취량 역시 영양상담 후에 유의하게 감소하였다(p<0.01). 이러한 연구의 결과로 웹상에서의 재진상담을 통하여 지속적이고 반복적인 추후관리가 효율적으로 이루어짐에 따라 고지혈증 환자에게 바람직한 식사섭취형태가 정착되고, 혈청 지질에도 긍정적인 효과를 줌으로서 정보화 시대에 맞는 새로운 영양상담 매체로서의 인터넷의 가능성을 제시하였다.

W15.411 The evalution of serum lipids in patients with acute stroke

W15.411 The evalution of serum lipids in patients with acute stroke

W15.411 The evalution of serum lipids in patients with acute stroke

Generally speaking, essential oils (EOs) and components of interest are extracted from plants using hydrodistillation (HD), steam distillation or organic solvent methods The Supercritical CO2 (SC-CO2) extraction technique is a good alternative to the three previously mentioned methods as it is able to be applied at temperatures close to ambient and shows no toxicity to humans or the environment. The aim of this study is to investigate the ability of supercritical CO2 extraction to extract bioactive components from four Corsican endemic plants: Rosmarinus officinalis, Juniperus communis ssp nana, Helichrysum italicum and Pistacia lentiscus. After the extracts were analyzed by gas chromatography, it would appear that SC-CO2 is the most adapted process for the extraction of such components of interest as verbenone, germacrene D, bornyl acetate, ferruginol, trans-caryophyllene, elemol, γ-cadinene, geraniol or β-eudesmol in higher quantity. The SC-CO2 extraction curves were obtained using two models published by Sovová. These models give access to complementary information and help to estimate the values of some important data such as the possible maximal extraction yield for Helichrysum italicum and the end of the extraction period.

Apolipoprotein E gene polymorphism and serum lipids in patients with superficial fungal disease.

Superficial mycosis, including dermatophytic infections, tinea versicolor, and cutaneous candidiasis is mostly limited to the outer layers of the skin, nails, and mucous membranes. In this study, Apolipoprotein E (ApoE) polymorphism and lipoprotein cholesterol concentrations were compared between 42 patients with superficial fungal disease and 27 control subjects. Both the patients and controls were found to be normolipemic. The patients with superficial fungal disease had significantly higher concentrations of high-density cholesterol (HDL) compared to the control group (p=0.0462). However, there was no difference in the serum triglyceride, low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) cholesterol concentrations. A significantly higher incidence of heterozygosity E2/3 was found in the patients (p=0.0228), and significantly lower incidence of homozygosity E3/3 in all patients, and those with candidiasis and dermatophytosis (p=0.0139, 0.0194 and 0.0337, respectively) compared to the control group. The E3/4 genotype differences between patients and controls were not statistically significant. There were slight differences in the allele frequencies between the two groups, but these did not reach statistically significant levels. It was concluded that the presence of apoE2/3 genotype, high HDL-cholesterol levels and the absence of apoE3/3 genotype can be regarded as risk factors for superficial fungal disease, especially dermatophytosis.

Retrospective survey of serum lipids in patients receiving more than three courses of isotretinoin

Isotretinoin is well recognised to cause hyperlipidaemia. This is most obvious during the second month of a 4‐month course. Since there are no long‐term data on lipid profiles, we have identified 30 subjects who have received 3 or more courses of isotretinoin. They had been exposed to a median of 24.5 months (range 12–103) isotretinoin therapy with a median total cumulative dose of 350 mg/kg (range 152–1221). The median serum cholesterol pre‐treatment was 4.6 mmol/L (range 3–6.4). This compared to a median of 4.5 mmol/L (range 3–6.4) just prior to starting the final course. The median triglyceride levels before treatment and pre‐final course were 0.8 mmol/L (range 0.3–1.7) and 0.92 mmol/L (range 0.4–2.6) respectively, indicating no significant change in cholesterol or triglyceride concentrations when measured prior to the first and last courses. In addition there was no correlation between cholesterol or triglyceride concentration before the final course of isotretinoin and the total cumulative dose of isotretinoin. We conclude that there appears to be little risk of causing hyperlipidaemia by prolonged therapy with isotretinoin in patients with acne.

The effect of atorvastatin on erythrocyte membranes and serum lipids in patients with type-2 hypercholesterolemia.

. The beneficial effects of statins on clinical events may involve mechanisms that modify endothelial dysfunction, plaque stability, thrombus formation, and inflammatory responses. To determine the effect of atorvastatin on blood rheology in patients with familial hypercholesterolemia (FH), we prospectively studied serum lipid concentration, red cell cholesterol content, lipid peroxidation and erythrocyte membrane fluidity. The aim of this paper was to evaluate the effects of atorvastatin therapy on the erythrocyte membrane structure and the hypolipemic efficacy in patients with FH. MATERIALS, METHODS AND SUBJECTS STUDIED:. The study involved 31 patients with FH and 20 healthy individuals as a control group. The program lasted 20 weeks. For the first 8 weeks, the patients were on a hypolipemic diet only and for the subsequent 12 weeks, alongside the diet they were given 10 mg atorvastatin per day. Laboratory tests were carried out before and after 4 weeks and 12 weeks of the pharmacological treatment. Erythrocyte membrane fluidity was determined using the spin labeled method. The peroxidation of lipids was measured in whole erythrocytes as well as in erythrocyte plasma membranes by means of the thiobarbituric acid technique. . Treatment with atorvastatin reduced serum total cholesterol concentration from 310+/-29 mg/dl in a basal situation to 203+/-34 mg/dl ( P<0.001) at the end of the treatment and low-density lipoprotein (LDL) cholesterol concentration from 225+/-30 mg/dl to 126+/-30 mg/dl ( P<0.001), respectively. The changes observed in the plasma lipids correlate with a significant decrease in erythrocyte membrane cholesterol, from 2.24+/-1.69 to 1.17+/-0.75 mg/mg protein ( P<0.001) after 12 weeks of treatment. The lipid peroxidation in membranes of erythrocytes was lowered from the basal value 0.171+/-0.097 to 0.100+/-0.024 mmol/mg protein ( P<0.05) after 4 weeks of treatment and to 0.057+/-0.020 mmol/mg protein ( P<0.001) after 12 weeks of treatment, and in total erythrocytes from 4.78+/-1.49 to 3.99+/-1.39 mmol/g Hb ( P<0.02) and 2.43+/-0.87 mmol/g Hb ( P<0.001), respectively. The membrane fluidity was estimated by means of parameter S at the depth of the fifth carbon atom. Atorvastatin in hypercholesterolemic erythrocytes enhances the fluidity of the superficial layer from 0.758+/-0.009 up to the values observed in the control group 0.744+/-0.009 ( P<0.001). There is no impact on the microviscosity of the hydrophobic core observed. . Our findings suggest that the atorvastatin therapy reverses the alteration of erythrocyte plasma membrane properties. It may improve blood rheology in patients with FH. This improvement in blood properties may contribute to the well-known beneficial effects of atorvastatin on cardiovascular risk in patients with severe hyperlipidemia and atherosclerotic vascular disease.

Association of Leucine 7 to Proline 7 Polymorphism in the Preproneuropeptide Y with Serum Lipids in Patients with Coronary Heart Disease

Leucine 7 (Leu7) to proline 7 (Pro7) substitution in the neuropeptide Y (NPY) gene has been associated with higher serum total and low-density lipoprotein (LDL) cholesterol levels, particularly in obese subjects. We investigated the frequency of the Pro7 allele and the association of the polymorphism with serum lipid levels in patients with coronary heart disease (CHD). A total of 414 CHD patients (mean age 61 years, range 33–74) participated in the cross-sectional EUROASPIRE study. Of the subjects 39% used lipid-lowering drugs. The frequency of the Pro7 allele in CHD patients (0.082) did not differ from that in control subjects (0.071). The mean (±SD) serum total cholesterol concentration was higher in women with the Pro7 allele (7.57 ± 0.57 mmol/L, n = 8) than in women with the Leu7Leu genotype (6.69 ± 1.01 mmol/L, n = 69, P = 0.019), when subjects using lipid-lowering medication were excluded. In contrast, serum total cholesterol concentration did not significantly differ between the genotypes in men. The Leu7Pro polymorphism was not associated with serum LDL, high-density lipoprotein (HDL) cholesterol, and triglyceride concentrations. In conclusion, the Pro7 allele in the NPY gene was associated with higher serum total cholesterol concentration only in women with CHD who did not use lipid-lowering drugs.

Serum ex vivo lipoprotein oxidizability in patients with ischemic heart disease supplemented with vitamin E

The decreased oxidizability of plasma lipoproteins is related to the increased vitamin E intake and its association with a relatively lower incidence of coronary heart disease has been proposed. We investigated the effect of the in vivo vitamin E supplementation on the oxidizability of serum lipids in patients with ischemic heart disease and a moderate hypercholesterolemia. Thirty-two patients (16 males and 16 postmenopausal women) participated in this placebo-controlled, randomized trial. They were treated with 400 mg vitamin E/day for 6 weeks. The copper-induced serum lipid oxidizability ex vivo was assessed by measuring conjugated diene formation at 245 nm. We also measured vitamin E, malondialdehyde (MDA) and uric acid concentrations in the plasma. Because of observed significant differences in parameters of serum lipid oxidizability (lag time and maximal rate of oxidation), plasma a-tocopherol and MDA levels between male patients and postmenopausal women supplemented with vitamin E, the results were compared between both genders. Six weeks of vitamin E supplementation significantly increased plasma vitamin E levels (by 87 %) in male patients but in postmenopausal women only by 34 %. Concomitantly with increased plasma levels of vitamin E the decrease in plasma MDA levels was observed in male patients (decrease by 20 %; p=0.008), but in postmenopausal women the decrease did not attain statistical significance. Plasma uric acid levels were not apparently changed in placebo or vitamin E supplemented groups of patients. The changes in ex vivo serum lipid oxidizability after vitamin E, supplementation have shown a significantly prolonged lag time (by 11 %; p=0.048) and lowered rate of lipid oxidation (by 21 %; p=0.004) in male patients in comparison with postmenopausal women. Linear regression analysis revealed a significant correlation between plasma vitamin E levels and the lag time (r=0.77; p=0.03) and the maximal rate of serum lipid oxidation (r=-0.70; p=0.05) in male patients. However, in postmenopausal women the correlations were not significant. We conclude that 400 mg vitamin E/day supplementation in patients with ischemic heart disease and a moderate hypercholesterolemia influenced favorably ex vivo serum lipid oxidation of male patients when compared with postmenopausal women. The observed differences between both genders could be useful in the selection of the effective vitamin E doses in the prevention of coronary heart disease.

Effect of atorvastatin 15 mg/week on serum lipids in patients with hypercholesterolemia

Atorvastatin 15 mg/week was administered to 21 patients with hypercholesterolemia for 2 months. The mean low-density lipoprotein concentration decreased by 20% after treatment.

Dietary Associates of Serum Total, LDL, and HDL Cholesterol and Triglycerides in Patients with Coronary Heart Disease

Background. Diet–lipid associations established in clinical trials have in general been weak or nonexistent in cross-sectional studies within a population. Our objective was to analyze the dietary associates of serum lipids in patients with coronary heart disease (CHD) not using lipid-lowering medication.Methods. Patients with coronary bypass grafting (n = 49), balloon angioplasty (n = 46), acute myocardial infarction (n = 79), and acute myocardial ischemia (n = 79) participated in a survey (EUROASPIRE). Patients were selected from hospital records at least 6 months after hospitalization. Diet was assessed by a food record, a short questionnaire, and fatty acid composition of serum cholesteryl esters (CE).Results. Neither the intake of total fat nor that of saturated, monounsaturated, or polyunsaturated fatty acids was associated with serum lipids. Use of soft margarine on bread (though not in cooking or baking) and high intake of fiber and cereal products were associated with low total cholesterol. Linoleic acid in CE was inversely associated with total cholesterol and triglycerides, and eicosapentaenoic acid was inversely associated with triglycerides and positively associated with HDL cholesterol.Conclusions. In the present study use of soft margarine on bread (though not in cooking or baking) and high intake of fiber and cereal products were associates of lowered serum cholesterol concentrations in CHD patients. Fatty acid composition of CE reflected dietary fatty acid intake involved in cholesterol lowering better than food records.

Effect of apolipoprotein E gene Hha I restricting fragment length polymorphism on serum lipids in cholecystolithiasis.

AIM:To investigate the role of apolipoprotein E (apoE) polymorphism in the lithogenesis of gallstone and the hereditary pathogenesis of the disease.METHODS: Polymerase chain reaction (PCR) was used to study apoE phenotypes and allele frequencies in patients with gallstones and control, and the fasting serum lipids of subjects were also measured by enzymatic methods.RESULTS:The levels of triglyceride (TG) and very low density lipoprotein cholesterol (VLDL-C) were much higher in E(2/3) patients than that in E(2/3) control. E(3/3) patients were accompanied with remarkably low levels of high density lipoprotein cholesterol (HDL-C) and its subforms.But in E(3/4) patients there were only slight changes in levels of VLDL-C and low density lipoprotein cholesterol (LDL-C).CONCLUSION:Different apoE phenotype patients with gallstones have different cheracteristics of dyslipidemia and the average level of serum lipids in patients with gallstones are higher than subjects without gallstones in the same apoE gene phenotype.epsilon2 allele is possibly one of the dangerous factors in the lithogenesis of cholecystolithiasis.

Long-Term Intraindividual Variability of Serum Lipids in Patients With Type I and Type II Diabetes

The objective of this study was to estimate the long-term intraindividual variability of lipid levels in adult type I and type II diabetic patients. Total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and hemoglobin A 1c were measured every 3–6 months in 135 patients attending the Austin Hospital diabetes clinic. Analysis was performed on 60 diabetic patients (33 type I and 27 type II) who had not been treated with lipid lowering drugs and who met the inclusion criteria of at least five measurements [mean ± standard error of the mean (SEM), 9.5 ± 0.4; range, 5–17] collected over a minimum of 4 years (5.1 ± 0.1; 4–6.5 years). Total variability, expressed as coefficient of variation, was 8.8 ± 0.4% for total cholesterol, 23.9 ± 1.5% for triglycerides, 10.2 ± 0.5% for HDL cholesterol, and 12.0 ± 0.5% for LDL cholesterol. Biological variability, derived from total and analytical variability, was higher than previous estimates in nondiabetic subjects for total cholesterol and HDL cholesterol but similar for triglycerides and LDL cholesterol. No relationship was observed between total lipid variability and diabetes type, age, baseline or mean lipid levels, duration of follow-up, or the number of samples per patient. Men demonstrated greater variability than women for total cholesterol men 9.5 ± 0.5%, n = 34, women 7.9 ± 0.5%, n = 26, p < 0.01 and triglycerides men 26.5 ± 2.2%, women 20.4 ± 1.4%, p = 0.03 . Total lipid variability was also unrelated to baseline or mean hemoglobin A 1c or to the change in hemoglobin A 1c during the study as a whole. However, the change in hemoglobin A 1c was associated with the change in total cholesterol ( r = 0.30, p < 0.03) and the change in LDL cholesterol ( r = 0.27, p < 0.05). In conclusion, long-term intraindividual lipid variability in adult diabetic subjects is higher for total and HDL cholesterol than previously published values in nondiabetic subjects. Variability of triglycerides is at least double that of total cholesterol, HDL cholesterol and LDL cholesterol. Biological variability, not measurement error, accounts for the greatest proportion of total variability for all lipid parameters. Confidence levels calculated from these data have implications for the initiation of lipid lowering therapy and in monitoring the effects of intervention.

Atherogenic risk factors in patients with gout.

In recent years, atherosclerotic diseases such as ischemic heart disease have become an important cause of death in Japanese patients with gout.1 However, since it remained undetermined whether or not hyperuricemia per se is an independent risk factor for atherosclerosis, we investigated the possible risk factors for atherosclerosis including serum lipids in patients with gout.

Lipids in serum of patients with malignant ovarian neoplasms

Objective: In numerous papers, different associations of serum lipids and lipoproteins with neoplastic diseases were found. The aim of our work was to find out associations between levels of 11 serum lipids, lipoproteins and ovarian cancer. Methods: 25 healthy women and 25 patients with ovarian cancer underwent examinations. Uni- and multivariate analysis of variance and discrimination analysis were used to analyze our results. Results: The analysis demonstrates that ovarian carcinoma is associated with a significant reduction of total cholesterol and its esters in serum and in high density lipoprotein fractions compared to controls. Conclusion: It could be shown that using multivariate analysis of variance it is possible to find the optimal set of serum lipid parameters, containing serum esterified cholesterol, serum total cholesterol and high density lipoproteins esterified cholesterol, to differentiate healthy persons from patients affected by ovarian cancer.

Diabetic retinopathy and lipid abnormalities.

The relationship of serum lipid levels and diabetic retinopathy has interested clinicians for several decades. Data from both a population-based study of diabetic retinopathy and a controlled, randomized trial of laser photocoagulation and aspirin treatment in diabetic retinopathy have provided further information regarding the importance of the role of serum lipids in patients with elevated serum lipid levels and diabetic retinopathy. Retinal hard exudate, which is accompanied by macular edema, is associated with elevated serum lipid levels. Although the data are observational, visual loss is likely to be associated with retinal hard exudate and serum lipid abnormalities. These relationships are evaluated in the analyses of the data from the Early Treatment Diabetic Retinopathy Study.

Serum Lipids in Patients with Hodgkin's Disease in Complete Remission

Serum Lipids in Patients with Hodgkin's Disease in Complete Remission

Long-term effects of eicosapentaenoic acid on diabetic peripheral neuropathy and serum lipids in patients with type II diabetes mellitus

The present study was undertaken to investigate the efficacy of a new, highly purified (purity greater than 91%), ethyl esterification product from natural eicosapentaenoic acid (EPA-E, C20:5 ω3) in patients with type II diabetes mellitus (NIDDM). Hemodynamic changes were assessed at the level of the dorsalis pedis artery using an ultrasonic color Doppler duplex system before and after oral administration of EPA-E at a dose of 1800 mg/day for 48 weeks. The cross-sectional area of the dorsalis pedis artery increased significantly from 2.5 ± 0.2 to 3.9 ± 0.4 mm 2 (48 weeks, mean ± SE, p < 0.05). Moreover, EPA-E improved the clinical symptom (coldness, numbness) as well as the vibration perception threshold sense of the lower extremities [from 32.1 ± 8.5 to 16.1 ± 4.8 (48 weeks) μm]. A significant decrease of serum triglycerides was also noted by EPA-E administration. Furthermore, significant decrease of the excretion of albumin in urine [from 24.4 ± 3.3 to 13.9 ± 1.8 (48 weeks) mg/g·Cr, p < 0.05]. The results of this study suggest that EPA-E has significant beneficial effects on diabetic neuropathy and serum lipids as well as other diabetic complications such as nephropathy and macroangiopathy.

Effect of dietary fish oil supplementation on peroxidation of serum lipids in patients with non-insulin dependent diabetes mellitus

Lipid peroxidation may be important in the development of cardiovascular disease, a common cause of mortality and morbidity in non-insulin dependent diabetes mellitus (NIDDM). We assessed the degree of lipid peroxidation by measuring plasma malondialdehyde, as thiobarbituric acid reacting substances (TBARS), in 23 non-insulin dependent diabetic patients. Plasma levels of lipid standardised α-tocopherol (vitamin E), lipid content of whole plasma and lipoprotein fractions, glycosylated haemoglobin, glycosylated low density lipoprotein (LDL) and fasting blood glucose were also measured. On completion of the baseline studies patients randomly received either fish oil or matching olive oil capsules in a double blind crossover fashion for 6 weeks followed by a 6 week washout period and a final 6 week treatment phase. Studies, identical to the initial baseline studies, were performed at the end of the active treatment periods at 6 and 18 weeks. Treatment with olive oil did not change levels of TBARS, vitamin E or indices of glycaemic control compared with baseline. Total cholesterol and triglyceride (TG) content of plasma and lipoprotein fractions were not significantly altered. Treatment with fish oil resulted in elevation of TBARS ( P < 0.001) and reduction of vitamin E ( P < 0.01) compared with baseline and olive oil treatment. Plasma cholesterol was unchanged. A reduction in plasma TG compared with baseline occurred but failed to reach significance ( P = 0.07). Changes in apo B containing lipoproteins induced by fish oil failed to reach significance. No significant changes were observed in the concentration or composition of high density lipoprotein (HDL). Fish oil treatment showed no change in glycaemic control as assessed by glycosylated haemoglobin and LDL although a rise in fasting blood glucose just failed to reach significance ( P = 0.06). Lipid peroxidation in NIDDM can be exacerbated by dietary fish oil. This potentially adverse reaction may limit the therapeutic use of fish oils in such patients.