Health for life

The omega 3 fatty acids in fish oil have long been thought to protect against cardiovascular disease—so much so that the American Heart Association currently recommends eating at least two servings of fish a week, particularly fatty varieties rich in omega 3s. However, the mechanism behind this protective effect still remains a mystery.

In a new study, scientists led by Jason R. Carter of Michigan Technological University shed light on this phenomenon by providing evidence that fish oil might specifically counteract the detrimental effects of mental stress on the heart. Their findings show that volunteers who took fish oil supplements for several weeks had a blunted response to mental stress in several measurements of cardiovascular health, including heart rate and muscle sympathetic nerve activity (MSNA), part of the "fight or flight" response, compared to volunteers who took olive oil instead. The results may explain why taking fish oil could be beneficial to the heart and might eventually help doctors prevent heart disease in select populations.

The article is entitled "Fish Oil and Neurovascular Reactivity to Mental Stress in Humans." It appears in the May edition of the American Journal of Physiology – Regulatory, Integrative, and Comparative Physiology, published by the American Physiological Society. It is available online at http://bit.ly/10j0CSS

Methodology

Carter and his colleagues worked with 67 adult volunteers. At the beginning of the study, each volunteer underwent a battery of tests to assess cardiovascular function, including heart rate, blood pressure, MSNA, and blood flow through the forearm and calf. These tests were performed first when the volunteers were at rest, and then again while they were performing a mental arithmetic test while the investigator encouraged them to hurry, a situation designed to induce acute mental stress. The study subjects were then nearly equally assigned to take either 9 grams of fish oil per day or 9 grams of olive oil, a placebo that hasnt been shown to have the same beneficial cardiovascular effects as fish oil. None of the volunteers were aware of which supplement they were taking. After 8 weeks of this intervention, the study subjects underwent the same tests again.

Results

The researchers found that test results didnt change between the two groups of study subjects when they were at rest. However, results for the volunteers who took fish oil and those who received the placebo differed significantly for some of the tests during the mental stress. Those in the fish oil group showed blunted heart rate reactivity while they were stressed compared to those who took olive oil. Similarly, the total MSNA reactivity to mental stress was also blunted in the fish oil group.

Importance of the Findings

These results show that fish oil could have a protective effect on cardiovascular function during mental stress, a finding that adds a piece to the puzzle on why taking fish oil helps the heart stay healthy, the authors suggest. Future studies might focus on the effects of taking fish oil for longer time periods and examining this effect on older populations or people with cardiovascular disease.

"Overall," the study authors say, "the data support and extend the growing evidence that fish oil may have positive health benefits regarding neural cardiovascular control in humans and suggest important physiological interactions between fish oil and psychological stress that may contribute to disease etiology."

D.C. deals with health insurers

As Disease Management Care Blog readers are aware (for example, here and here), Obamacare forces health insurers to spend at least 80% (small group) to 85% (large group) of their premium income on health care, leaving only 15% for "other," including administrative overhead and profits. If that 80%-85% "medical loss ratio" (MLR) threshold is not met, insurers have to rebate the difference to their customers.

 While the White House has been happy to extoll the millions of dollars that were repaid to consumers (even though the individual checks were hardly eye-popping and then there is the risk that theyre taxable), the DMCB is interested in what actually happened to the commercial insurers.  Did they game the system and garner even higher profits?  Or, have they gotten their comeuppance, are now losing money and have to pursue other lines of business, like covering zombie attacks?

This article in the latest Health Affairs looked at that impact of the law when it went into effect on January 1, 2011.  The authors used NAIC data to examine the impact on the individual (N=1,219), small group (N=804) and large group market (N=750) insurers.

Individual, small group and large group numbers are broken out below. If there is a *, the change is statistically significant.

In the individual market, from 2010 to 2011:

Median medical expenses, as a percent of premium, increased      by 5.5%*.
Administrative expenses, as a percent of premium, decreased            by 2.6%*.
Profit (otherwise known as "operating margin" or the bottom line) decreased by 1.3%*. "For profit" insurers fared even worse, with a decline in operating margin of 2.2%* vs. their nonprofit competition with a decline in 0.8%.

2011 operating margins were overall negative:

Individual overall -0.1%.
Nonprofits:  -3.5%.
For profits:  0.4%.

In the small group market:

Median medical expenses increased by 0.7%.
Median administrative expenses declined by 1%*.
The bottom line increased by .5%. Nonprofits saw an increase of 1.2%* vs. the for profits having a small decline of .3%.

2011 operating margins were positive, ranging from 2.8% to 3.8%  across the non and for profits, respectively.

In the large group market:
Median medical expenses declined by 0.7%.
Median administrative expenses declined by 0.9%%*.
Profit increased by .7%*. Nonprofits saw an increase of 0.1%* vs. the for profits having a increase of 1.2%.

2011 operating margins were positive, ranging from .7% to 2.6%  across the non and for profits, respectively.

The DMCBs take:

Obamacare had a single digit impact on health insurers.  More was spent on health care and less was spent on administrative costs.  While the shifts were relatively small, those changes represent swings of hundreds of millions of dollars to the bottom line in an already thin margin business. If the purpose of Affordable Care Act was to beat up on the health insurers, it was more of a push than a shove.

Small and large group profitability increased and operating margins were positive, while the individual market struggled. As readers may recall, the inability of individuals to obtain coverage at any price was a big factor in the eventual passage of the Affordable care Act. While the future individual market may eventually benefit from an influx of healthy young "invincibles" armed with an accompanying bolus of insurance subsidies, Obamacare ironically hurt the individual market in 2011. If health care utilization didnt go down in 2011 as a result of the economy, it could have been a lot worse.

That tells the DMCB that, contrary to the insurers reports of doom and gloom, the 80%-85% MLR rule hasnt been a catastrophe.  On the other hand, it hasnt been good news for the individual market.  If the young invincibles dont 1) respond to the individual mandate, 2) use functioning insurance exchanges and 3) sign up, it could portend further stress on that sector of the health care economy.  No wonder the Obama Administration is pushing that so hard.