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AHA supports prescription omega-3s for lowering triglycerides

August 28, 2019

By Reuters Staff

NEW YORK (Reuters Health) - Prescription omega-3 fatty acids (n-3 FAs) are effective and safe for managing high triglycerides, according to a new science advisory from the American Heart Association (AHA).

"When used to treat hypertriglyceridemia, n-3 FAs with EPA (eicosapentaenoic acid) + DHA (docosahexaenoic acid) or with EPA-only appear roughly comparable for triglyceride lowering and do not increase low-density lipoprotein cholesterol when used as monotherapy or in combination with a statin," Dr. Ann C. Skulas-Ray of the Arizona Center on Aging, in Tucson, and colleagues write in the statement, online August 19 in Circulation.

The U.S. Food and Drug Administration (FDA) has approved prescription n-3 FAs for treating very high triglyceride levels (at least 500 mg/dL), and the drugs are also often used in patients with hypertriglyceridemia (triglycerides 200-499 mg/dL), the authors note.

"Both are becoming increasingly prevalent in the United States and elsewhere, likely driven in large part by growing rates of obesity and diabetes mellitus," they add.

Four grams a day of n-3 FAs, regardless of whether they contain EPA alone or EPA with DHA, reduce triglycerides by at least 30% in patients with very high triglyceride levels, the authors note.

EPA+DHA formulations also increase low-density lipoprotein cholesterol in patients with very high triglycerides, they add, but EPA-only do not.

"The use of n-3 FA (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 EPA-only in high-risk patients treated with a statin," Dr. Skulas-Ray and her colleagues write.

In 2002, the AHA recommended 2 g to 4 g of EPA or DHA from diet and supplements for reducing triglycerides in patients with elevated levels. Prescription agents, which became available in 2004, are recommended over dietary supplements, according to the statement.

"Because these supplements are neither reviewed nor approved by the FDA, they are not indicated for triglyceride lowering in patients with any degree of elevation," the authors state.

"We conclude that prescription n-3 FAs, whether EPA+DHA or EPA-only, at a dose of 4 g/d, are clinically useful for reducing triglycerides, after any underlying causes are addressed and diet and lifestyle strategies are implemented, either as monotherapy or as an adjunct to other triglyceride-lowering therapies," they add.


Circulation 2019.

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