What is the best way to choose between EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) omega supplements for treating hypertriglyceridemia?

From the Guidelines

For treating hypertriglyceridemia, pure EPA supplements, such as icosapent ethyl, are the preferred choice over DHA supplements due to their superior efficacy in reducing triglyceride levels without raising LDL cholesterol. The most recent and highest quality study, 1, published in 2021, supports the use of prescription omega-3 fatty acid products, specifically pure EPA products like icosapent ethyl, for the treatment of hypertriglyceridemia. These products have demonstrated significant triglyceride reductions and cardiovascular outcome benefits in clinical trials. In contrast, DHA supplements may increase LDL cholesterol levels, which is undesirable for cardiovascular health.

When choosing between EPA and DHA supplements, it is essential to consider the potential benefits and risks of each. EPA supplements have been shown to reduce triglyceride levels by up to 45% without increasing LDL cholesterol, making them a more favorable option for patients with hypertriglyceridemia. Additionally, prescription omega-3 fatty acid products, such as icosapent ethyl, have been approved by the FDA for the treatment of hypertriglyceridemia and have demonstrated cardiovascular outcome benefits in clinical trials.

Some key points to consider when choosing an omega-3 supplement for hypertriglyceridemia include:

• The FDA-approved indication for the treatment of elevated triglycerides
• The efficacy and consistency of the product
• The potential for adverse effects, such as increased risk of atrial fibrillation
• The importance of taking the full dose with food, divided into two daily doses, for optimal results

Overall, the evidence suggests that pure EPA supplements, such as icosapent ethyl, are the preferred choice for treating hypertriglyceridemia due to their superior efficacy and safety profile compared to DHA supplements. As noted in 1, a dose-response relationship exists between marine-derived omega-3 PUFA and triglyceride lowering, with an approximate 5% to 10% reduction in triglycerides for every 1 g of EPA/DHA consumed. However, the most recent and highest quality study, 1, provides more specific guidance on the use of pure EPA products for the treatment of hypertriglyceridemia.

From the FDA Drug Label

ICOSAPENT ETHYL capsules, for oral use ...as an adjunct to diet to reduce TG levels in adult patients with severe (≥ 500 mg/dL) hypertriglyceridemia. The daily dose of icosapent ethyl capsules are 4 grams per day taken as either four 0.5 gram capsules twice daily with food or two 1 gram capsules twice daily with food.

The best way to choose between EPA and DHA omega supplements for treating hypertriglyceridemia is to select a supplement that contains EPA, as it is indicated for reducing TG levels in adult patients with severe hypertriglyceridemia, according to the drug label of icosapent ethyl capsules 2.

• Key points to consider when choosing an omega supplement:
  • EPA is indicated for reducing TG levels in adult patients with severe hypertriglyceridemia
  • The daily dose of EPA is 4 grams per day
  • EPA should be taken with food However, it is essential to consult a healthcare professional before making any decisions about omega supplements.

From the Research

Choosing Between EPA and DHA Omega Supplements for Hypertriglyceridemia

When selecting omega supplements for treating hypertriglyceridemia, it's essential to consider the differences between eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) formulations. Here are key points to consider:

• EPA vs. DHA: Both EPA and DHA are effective in reducing triglyceride levels, but DHA may increase low-density lipoprotein cholesterol levels, whereas EPA-only formulations do not have this effect 3.
• Formulations: Prescription omega-3 fatty acid formulations, including EPA ethyl esters (e.g., Vascepa) and omega-3 carboxylic acids (e.g., Epanova), are available for treating severe hypertriglyceridemia. These formulations have been shown to substantially reduce triglyceride and very-low-density lipoprotein levels 4, 5.
• Bioavailability: The bioavailability of omega-3 fatty acids can vary depending on the formulation. For example, omega-3 free fatty acid formulations (e.g., Epanova) have been shown to have improved bioavailability during a low-fat diet compared to omega-3-acid ethyl ester formulations (e.g., Lovaza) 6.
• Dosing: The recommended dose of EPA and DHA for triglyceride lowering is approximately 2-4 g/day, with 4 g/day being the most effective dose for reducing triglyceride levels 5, 3.
• Safety and Tolerability: Omega-3 fatty acid formulations are generally well-tolerated, with gastrointestinal adverse events being the most common side effect 4, 5, 7.

Key Considerations

When choosing between EPA and DHA omega supplements, consider the following:

• Triglyceride levels: If you have very high triglyceride levels (≥500 mg/dL), a formulation containing both EPA and DHA may be effective in reducing triglyceride levels 4, 5.
• Low-density lipoprotein cholesterol levels: If you have concerns about increasing low-density lipoprotein cholesterol levels, an EPA-only formulation (e.g., Vascepa) may be a better option 3, 7.
• Diet: If you are on a low-fat diet, an omega-3 free fatty acid formulation (e.g., Epanova) may have improved bioavailability compared to omega-3-acid ethyl ester formulations 6.