Tucson, AZ—With all of the hype about the benefits of omega-3 fatty acids, how effective are they in patients with high triglyceride levels?

A science advisory from the American Heart Association provides an answer, stating that prescription omega-3 fatty acid medication reduces triglyceride levels by 20% to 30% among the majority of people who require treatment for high triglyceride levels.

“From our review of the evidence from 17 randomized, controlled clinical trials on high triglyceride levels, we concluded that treatment with 4 grams daily of any of the available prescription choices is effective and can be used safely in conjunction with statin medicines that lower cholesterol,” said first author Ann Skulas-Ray, PhD, of the University of Arizona in Tucson. The new science advisory was published in the journal Circulation.

Background information in the article states that, in a 2002 American Heart Association scientific statement, the omega-3 fatty acids (n-3 FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were recommended (at a dose of 2-4 g/d) for reducing triglycerides in patients with elevated triglycerides. Since 2002, prescription agents containing EPA+DHA or EPA alone have been approved by the FDA for treating very high triglycerides and are also widely used for hypertriglyceridemia.

On the basis of new scientific data and availability of n-3 FA agents, the AHA opted to summarize the lipid and lipoprotein effects resulting from pharmacological doses of n-3 FAs (>3 g/d total EPA+DHA). The advisory does not recommend one formulation over another, however. One prescription product combines two types of fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), while the other provides EPA only.

It is important to use a prescription product, Skulas-Ray advises, suggesting that treating high triglyceride levels with nonprescription, omega-3 fatty acid fish oil supplements can be risky, explaining, “Dietary supplements containing omega-3 fatty acids are not regulated by the FDA. They should not be used in place of prescription medication for the long-term management of high triglycerides.”

In a 2017 science advisory, the American Heart Association noted that there is a lack of scientific research to support clinical use of omega-3 fatty acid supplements to prevent heart disease in the general population. The FDA has approved prescription omega-3 fatty acid medications only for very high triglyceride levels above 500 mg/dL.

The advisory notes that the effective dose for prescription omega-3 fatty acids is four grams per day taken with food.

In analyzing the current scientific data, the advisory panel found:
• For most people with high triglycerides (200-499 mg/dL), prescription doses of omega-3 fatty acids using drugs with either EPA+DHA or EPA alone can reduce triglyceride by 20% to 30%.
• Despite concerns, the formula that contains both EPA and DHA does not increase LDL-C among most patients with high triglyceride levels (200-499 mg/dL). When the drug is given to those with very high triglyceride levels at 500 mg/dL or greater, however, LDL-C may increase.
• Prescription omega-3 drugs are effective in reducing triglyceride levels regardless of whether people are on statin therapy, the panel found.
• In a recent large, randomized, placebo-controlled study, REDUCE-IT, researchers determined that the EPA-only medication combined with statin medication resulted in a 25% reduction in major cardiovascular events, defined as heart attack, stroke, and cardiovascular death, among people with high triglycerides.

About 25% of adults in the U.S. have a triglyceride level above 150 mg/dL, which is considered borderline high, according to the report.

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