Is fish oil (Omega-3 fatty acids) effective for reducing elevated triglycerides (hypertriglyceridemia)?

From the Guidelines

For individuals with elevated triglycerides, I strongly recommend taking 2-4 grams of prescription-grade omega-3 fatty acids daily, such as Lovaza, Vascepa, or Epanova, as they have been shown to be effective in lowering high triglyceride levels 1. The American Heart Association also recommends 2 to 4 g of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) per day for patients who need to lower their triglyceride level 1. Some key points to consider when using fish oil supplements include:

• Starting with 1 gram daily and gradually increasing to the recommended dose to minimize potential side effects like fishy aftertaste or mild gastrointestinal discomfort
• Taking the supplements with meals to improve absorption and reduce digestive issues
• Combining fish oil supplementation with lifestyle modifications including reducing sugar and refined carbohydrate intake, limiting alcohol consumption, increasing physical activity, and maintaining a healthy weight
• Significant triglyceride reductions of 20-50% can be expected within 2-3 months of consistent use, particularly in those with very high baseline levels It's also important to note that prescription omega-3 fatty acid preparations have been demonstrated to have cardiovascular outcomes benefits, whereas nonprescription fish oil products have not 1. Some potential side effects of prescription omega-3 fatty acid preparations include eructation, dyspepsia, taste perversion, musculoskeletal pain, peripheral edema, constipation, gout, and atrial fibrillation 1. Overall, the use of prescription-grade omega-3 fatty acids, such as Lovaza, Vascepa, or Epanova, is a highly effective way to lower high triglyceride levels, and should be considered as part of a comprehensive treatment plan.

From the FDA Drug Label

LOVAZA is a combination of ethyl esters of omega 3 fatty acids, principally EPA and DHA, indicated as an adjunct to diet to reduce triglyceride (TG) levels in adult patients with severe (≥500 mg/dL) hypertriglyceridemia (HTG). The daily dose of LOVAZA is 4 grams per day taken as a single 4-gram dose (4 capsules) or as two 2-gram doses (2 capsules given twice daily). LOVAZA may reduce the synthesis of triglycerides in the liver because EPA and DHA are poor substrates for the enzymes responsible for TG synthesis, and EPA and DHA inhibit esterification of other fatty acids.

Fish Oil for Triglycerides:

• Indication: Lovaza (fish oil) is indicated as an adjunct to diet to reduce triglyceride (TG) levels in adult patients with severe (≥500 mg/dL) hypertriglyceridemia (HTG) 2, 2, 2.
• Dosage: The daily dose of Lovaza is 4 grams per day taken as a single 4-gram dose or as two 2-gram doses 2.
• Mechanism of Action: Lovaza may reduce the synthesis of triglycerides in the liver because EPA and DHA are poor substrates for the enzymes responsible for TG synthesis, and EPA and DHA inhibit esterification of other fatty acids 2.

From the Research

Fish Oil for Triglycerides

• Fish oil, which contains omega-3 fatty acids, has been shown to be effective in lowering triglyceride levels 3, 4, 5, 6.
• The optimal dose of omega-3 fatty acids for lowering triglycerides is 3-4 g/day, with little evidence to support lipid-altering efficacy of doses <1g/day 5.
• Omega-3 fatty acids have been shown to reduce triglyceride levels by 25-35% up to 45% in the presence of severely elevated triglyceride levels (≥ 500 mg/dl) 5.
• In addition to lowering triglycerides, omega-3 fatty acids have also been shown to reduce non-high-density lipoprotein cholesterol and increase high-density lipoprotein cholesterol 5.
• The 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 in the REDUCE-IT trial 4.

Comparison with Other Treatments

• Fibrates and niacin are also effective in lowering triglyceride levels, but may have different benefit-risk profiles compared to omega-3 fatty acids 6.
• Statins are the first line of therapy for the management of mild to moderate hypertriglyceridemia, but may not be sufficient to reduce triglyceride levels in all patients 6.
• The addition of fibrates, niacin, or omega-3 fatty acids may be necessary for patients with persistent hypertriglyceridemia despite statin therapy 6.

Patient Selection

• Patients with severely elevated triglyceride levels (≥ 500 mg/dl) may benefit from immediate use of triglyceride-lowering agents, including omega-3 fatty acids 6.
• Patients with hypertriglyceridemia who are at high risk for cardiovascular disease may benefit from the use of omega-3 fatty acids to reduce their risk 4, 7.