Mental Health, Physical Health | Four grams per day of omega-3 fatty acids, specifically eicosapentaenoic acid and docosahexaenoic acid together or eicosapentaenoic acid alone, is clinically useful as monotherapy or in addition to other therapies to reduce triglycerides after implementing diet and lifestyle changes and addressing any underlying causes, according to an American Heart Association science advisory published in Circulation.
“From our review of the evidence from 17 randomized controlled clinical trials on high triglyceride levels, we concluded that treatment with 4 g daily of any of the available prescription choices is effective and can be used safely in conjunction with statin medicines that lower cholesterol,” Ann C. Skulas-Ray, PhD, assistant professor in the department of nutritional sciences at The University of Arizona College of Agriculture and Life Sciences in Tucson and member of the writing group, said in a press release.
Several prescription versions of omega-3 fatty acids have been approved by the FDA including omega-3 acid-ethyl esters (Lovaza, SmithKline Beecham), omega-3 acid ethyl esters type A (Omtryg, Osmotica), icosapent ethyl (Vascepa, Amarin) and omega-3 carboxylic acid (Epanova, AstraZeneca), according to the science advisory.
Omega-3 acid-ethyl esters, icosapent ethyl and omega-3 carboxylic acid have all been tested at 4 g per day and resulted in reductions in plasma triglyceride levels by 30% to 35% in patients with baseline levels of 600 mg/dL to 800 mg/dL.
Despite these benefits with omega-3 fatty acids, patients with very high triglycerides may need multiple mediations in addition to changes in lifestyle and diet to achieve acceptable triglyceride levels, according to the science advisory. Data are limited regarding the use of omega-3 fatty acids with nonstatin therapy for the treatment of these patients.
The writing group analyzed data from 17 trials that focused on patients with high triglycerides between 200 mg/dL and 499 mg/dL. Omega-3 fatty acids as monotherapy were found to reduce triglycerides in these patients, according to the science advisory.
Patients also had reductions in triglycerides between 22% and 31% when omega-3 fatty acids were added to a statin or ezetimibe. Data are limited on the effects of omega-3 fatty acids when combined with niacin and fibrates, according to the science advisory.
Triglycerides are an important risk factor for CVD and are highly prevalent in the population. The first step in treating elevated triglycerides is controlling risk factors, including weight loss, tight control of diabetes, exercise, avoiding refined carbohydrates and decreasing alcohol consumption.
Triglyceride-lowering agents can be used with other medications such as statins and fibrates in a safe and efficacious way. We know that omega-3 fatty acids have indications beyond just lowering triglycerides, and based on recent trials like REDUCE-IT, they might be associated with a mortality benefit and significant reduction in CV events in patients with established CVD and high-risk patients requiring primary prevention.
We live in an era where multiple medications have been shown to improve cardiac outcomes. A clinician has to choose right medication for each patient. That comes down to shared decision making with the patient about type of medication to choose, in addition to looking at cost and figuring out what payers will cover.
We need more studies looking at benefits of using these medications in high vs. low risk patients for primary and secondary prevention. We need to find out more about those differences. Head-to-head studies comparing these medications would be something to look forward to. We know these medications are safe and well tolerated, but we need to be careful about over-the-counter products that are not FDA-approved in terms of their safety profile long-term.
We live in exciting time where there are multiple medications and multiple treatment options to lower lipids, which translates to lower CV risk factors, which results in longer, healthier lives.
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