From the Guidelines
Prescription-grade omega-3 fatty acids, specifically 4 grams per day of purified EPA (as IPE), are recommended for treating hyperlipidemia, as evidenced by the REDUCE-IT trial 1.
Key Considerations
- The REDUCE-IT trial demonstrated a 25% reduction in the primary composite endpoint of cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina with 4 grams per day of EPA (as IPE) 1.
- Prescription-strength products containing purified, concentrated omega-3s with consistent potency are preferred over over-the-counter supplements.
- EPA has been shown to be more effective than a mixture of EPA and DHA in reducing triglyceride levels and cardiovascular risk.
Dosage and Administration
- The recommended dose is 4 grams per day of purified EPA (as IPE), taken with meals to improve absorption and reduce potential gastrointestinal side effects.
- Dividing the daily dose into two servings may help optimize results.
Mechanism of Action
- Omega-3 fatty acids, particularly EPA, work by reducing triglyceride production in the liver and enhancing triglyceride clearance from the bloodstream.
Efficacy and Safety
- Fish oil supplements, particularly those containing purified EPA, are effective at lowering triglycerides (by 20-50%) and have modest effects on LDL cholesterol and HDL cholesterol.
- Common side effects include fishy aftertaste, burping, and mild digestive discomfort, which can be minimized by refrigerating the capsules and taking them with food.
Clinical Context
- Fish oil supplements should complement, not replace, standard lipid-lowering medications like statins for most patients with hyperlipidemia.
- The REDUCE-IT trial 1 provides the strongest evidence for the use of prescription-grade omega-3 fatty acids in treating hyperlipidemia, and its findings should guide clinical decision-making.
From the FDA Drug Label
LOVAZA, a lipid-regulating agent, is supplied as a liquid-filled gel capsule for oral administration. Each 1-gram capsule of LOVAZA contains at least 900 mg of the ethyl esters of omega-3 fatty acids sourced from fish oils The recommended fish oil supplement for treating hyperlipidemia is Lovaza, which contains at least 900 mg of the ethyl esters of omega-3 fatty acids sourced from fish oils, predominantly a combination of EPA (approximately 465 mg) and DHA (approximately 375 mg) 2.
From the Research
Recommended Fish Oil Supplement for Treating Hyperlipidemia
- The recommended fish oil supplement for treating hyperlipidemia should contain both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) 3.
- Patients with hypertriglyceridemia may benefit from treatment with 3 to 4 g/d of DHA and EPA, which can lower triglyceride levels by 20% to 50% 3, 4.
- A prescription form of omega-3 fatty acids has been approved by the United States Food and Drug Administration as an adjunct to diet for the treatment of very high triglyceride levels, with a recommended dose of approximately 2-4 g/day of EPA and DHA 4.
- Fish oil supplementation produces a clinically significant dose-dependent reduction of fasting blood triglycerides, but not total, HDL or LDL cholesterol in hyperlipidemic subjects, with a weighted average daily intake of 3.25 g of EPA and/or DHA 5.
Important Considerations
- Dietary fish oil supplements may not be an appropriate substitute for FDA-approved prescription ω-3 fatty acids for the treatment of elevated triglycerides or the prevention of cardiovascular events due to limited regulatory oversight and evidence of quality concerns 6.
- The mechanism of action of omega-3 fatty acids in fish oil has been well documented, with reductions in plasma cholesterol and triglyceride concentrations, and changes in VLDL, chylomicrons, remnants, LDL, apo B, and apo E 7.
- Further studies are required to delineate exact doses and precise indications for different types of hyperlipidemia and to differentiate the effects of EPA and DHA 7.