AHA science advisory on lowering triglycerides with prescription omega-3 fatty acid medications
Prescription omega-3 fatty acid medication reduces triglyceride levels by 20-30% in those with high triglyceride levels, according to an American Heart Association (AHA) science advisory, which was 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 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 Ann Skulas-Ray, PhD, one of the authors of the new science advisory from the AHA.
Two prescription omega-3 fatty acid medications are available: one is a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the other contains only EPA. The advisory does not recommend one over the other, as there are no studies that compare the two. The effective dose for prescription omega-3 fatty acids is four grams per day taken with food. Omega-3 fatty acids are approved by the FDA for treating patients with triglyceride levels >500 mg/dL.
“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,” said Skulas-Ray. The 2017 science advisory from the AHA concluded there is no data supporting clinical use of omega-3 fatty acid supplements to prevent CVD in the general population.
Lfestyle changes, such as regular physical activity, losing weight, avoiding sugar and carbohydrates, limiting alcohol and eating unsaturated fats instead of saturated, should be addressed before prescribing drugs. In addition, it is important to first treat conditions such as poorly controlled type 2 diabetes, hypothyroidism and obesity that may contribute to high triglyceride levels. Fish is a good source of omega-3 fatty acids, and the AHA recommends eating fatty fish – such as salmon, mackerel, herring and albacore tuna – at least two times per week.
The advisory panel analyzed current scientific data and concluded:
- In people with high triglycerides (200 - 499 mg/dL), prescription dose of omega-3 fatty acids can reduce triglyceride by 20 to 30%.
- The combination of EPA and DHA does not increase LDL-c in those with high triglyceride levels (200-499 mg/dL), but may increase LDL-c in those with very high triglyceride levels ≥500 mg/dL.
- Prescription omega-3 drugs are effective in reducing triglyceride levels regardless of whether people are on statin therapy.
- In the large, randomized placebo-controlled REDUCE-IT trial, EPA-only combined with statin resulted in a 25% reduction in major CV events in people with high triglycerides.