What is the effect of Omega-3 (n-3 fatty acids) supplements on dyslipidemia?

From the Guidelines

Omega-3 supplements, specifically prescription-strength omega-3 fatty acids, are recommended for managing dyslipidemia, particularly for reducing triglyceride levels, at a dose of 4 grams daily, as evidenced by the most recent and highest quality study 1. When considering the management of dyslipidemia, it is essential to prioritize the reduction of triglyceride levels, as elevated triglycerides are associated with increased cardiovascular disease risk.

• The American College of Cardiology expert consensus decision pathway recommends the use of prescription-grade omega-3 fatty acids for patients with persistent hypertriglyceridemia 1.
• The REDUCE-IT trial, a multinational study with a randomized, placebo-controlled design, demonstrated a 25% reduction in the primary composite endpoint of cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina with 4 g of EPA daily versus mineral oil placebo 1.
• The study found that patients with triglycerides ≥150 mg/dL and low levels of HDL-C derived the greatest benefit from omega-3 supplementation 1.
• While over-the-counter fish oil supplements can also help reduce triglyceride levels, they typically require higher doses (2-4 grams daily) to achieve therapeutic effects and may have lower concentrations of omega-3s.
• It is crucial to note that omega-3 supplements work by decreasing hepatic production of triglycerides and increasing their clearance from circulation, with minimal effects on LDL cholesterol and a potential slight increase in HDL cholesterol.
• Common side effects of omega-3 supplements include fishy taste, gastrointestinal discomfort, and potential increased bleeding risk, emphasizing the need for patients to take these supplements with meals and continue other lipid-lowering medications as prescribed.
• Incorporating dietary sources of omega-3s, such as fatty fish (salmon, mackerel), into the diet twice weekly can complement supplementation and support overall cardiovascular health.

From the Research

Omega 3 Supplements and Dyslipidemia

• Omega 3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been shown to have a beneficial effect on triglyceride levels in patients with dyslipidemia 2, 3, 4, 5
• Prescription omega-3 fatty acid formulations, such as omega-3 fatty acid ethyl esters and icosapent ethyl (IPE), have been approved for the treatment of very high triglycerides and have been shown to lower triglyceride levels without raising low-density lipoprotein cholesterol (LDL-C) levels 2, 4, 5
• However, omega-3 fatty acid formulations containing both EPA and DHA may increase LDL-C levels, which could potentially offset their beneficial effects on triglycerides 2, 4
• Recent studies have demonstrated the effectiveness of omega-3 fatty acid supplements in reducing triglyceride levels and improving cardiovascular outcomes in patients with hypertriglyceridemia, including a 25% reduction in major adverse cardiovascular events in the REDUCE-IT trial 5
• The American Heart Association recommends the use of omega-3 fatty acid supplements, particularly EPA and DHA, for the management of hypertriglyceridemia, at a dose of 2-4 g/d 3, 5

Types of Omega 3 Supplements

• Prescription omega-3 fatty acid formulations, such as omega-3 fatty acid ethyl esters and IPE, are available for the treatment of very high triglycerides 2, 4
• Dietary supplements containing omega-3 fatty acids, including EPA and DHA, are also available, but their efficacy and safety may vary depending on the formulation and manufacturer 6, 4
• Functional foods, such as fish and krill oil, may also provide a source of omega-3 fatty acids, although their efficacy and safety for the management of dyslipidemia are not well established 6

Safety and Efficacy

• Omega-3 fatty acid supplements have been shown to be generally safe and well-tolerated, although high doses may cause gastrointestinal side effects 3, 4, 5
• The efficacy of omega-3 fatty acid supplements for the management of dyslipidemia may vary depending on the formulation, dose, and individual patient characteristics 2, 6, 3, 4, 5
• Further research is needed to fully establish the safety and efficacy of omega-3 fatty acid supplements for the management of dyslipidemia and to determine their optimal formulation and dosage 2, 6, 3, 4, 5