Omega-3 fatty acids safe, effective for reducing triglycerides
Use of omega-3 fatty acids for improving atherosclerotic cardiovascular disease risk in patients with hypertriglyceridemia is supported by a 25% reduction in major adverse cardiovascular events, according to the American Heart Association.
Prescription omega-3 fatty acids are an effective and safe option for reducing triglycerides as monotherapy or as an adjunct to other lipid-lowering agents, according to a Science Advisory from the American Heart Association (AHA).
The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were recommended in an AHA scientific statement in 2002 at a dose of 2 to 4 g/d for reducing triglycerides. Since 2002, the FDA has approved prescription agents with EPA and DHA or EPA alone for treating very high triglycerides (≥500 mg/dL). They are also widely used for hypertriglyceridemia (triglyceride levels of 200 to 499 mg/dL).
Among the AHA's conclusions were the following:
- In patients with triglyceride levels from 200 to 499 mg/dL, a prescription of 4 g of omega-3 fatty acids per day was associated with a 20% to 30% reduction in triglyceride levels with no increase in LDL cholesterol levels.
- In patients with triglyceride levels of 500 mg/dL of higher, a prescription of 4 g of omega-3 fatty acids per day was associated with a reduction of at least 30% in triglyceride levels, with an increase in LDL cholesterol levels with DHA-containing agents.
- Use of omega-3 fatty acids with statin therapy is safe and offers more triglyceride reduction. It is apparently also safe with fibrates or niacin, although more research is needed to evaluate efficacy.
- All omega-3 fatty acids available by prescription appear comparably effective, but head-to-head comparisons are lacking.
When used to treat hypertriglyceridemia, EPA/DHA and EPA-only formulations appear comparable for triglyceride lowering and do not increase LDL cholesterol levels when used as monotherapy or in combination with a statin, the advisory stated. In the largest trials of omega-3 fatty acid prescriptions of 4 g/d, non-HDL cholesterol and apolipoprotein B levels were modestly decreased, indicating reductions in total atherogenic lipoproteins. Using omega-3 fatty acids at a dose of 4 g/d for improving atherosclerotic cardiovascular disease risk in patients with hypertriglyceridemia is supported by a 25% reduction in major adverse cardiovascular events in REDUCE-IT (Reduction of Cardiovascular Events With EPA Intervention Trial), a randomized placebo-controlled trial of an EPA-only formulation in high-risk patients treated with a statin, according to the advisory.
The AHA's new Science Advisory was published by Circulation on Aug. 19.