From the Guidelines
I strongly advise against using nonprescription omega-3 oil as a long-term option due to concerns about quality, purity, and efficacy, and instead recommend prescription omega-3 fatty acid products for patients with elevated triglyceride levels and established cardiovascular disease or diabetes mellitus with additional risk factors, as supported by the 2021 ACC expert consensus decision pathway 1. When considering omega-3 oil for long-term use, it is essential to distinguish between nonprescription fish oil supplements and prescription omega-3 fatty acid products. Nonprescription fish oil supplements are not FDA-approved for treating elevated triglyceride levels, and their manufacturing process is not as strictly regulated as that of prescription medications, which can lead to variability in content and quality 1. Some key points to consider include:
- Nonprescription fish oil products may contain impurities, such as saturated fat, oxidized lipids, contaminants, or other ingredients that could be harmful 1.
- Prescription omega-3 fatty acid products, on the other hand, have been shown to lower very high triglyceride levels and reduce the risk of cardiovascular events in patients with established cardiovascular disease or diabetes mellitus with additional risk factors 1.
- The most recent and highest quality study, REDUCE-IT, 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 (in the form of IPE) daily versus mineral oil placebo 1.
- However, it is crucial to note that prescription omega-3 fatty acid products can increase the risk of atrial fibrillation, particularly at higher doses, as observed in the REDUCE-IT, OMEMI, and STRENGTH trials 1.
- Therefore, prescription omega-3 fatty acid products should only be used under the guidance of a healthcare provider, who can evaluate the potential net benefit and monitor for adverse effects, particularly in patients at high risk of atrial fibrillation.
From the Research
Benefits of Omega-3 Oil
- Omega-3 oil, particularly EPA and DHA, has been shown to have triglyceride-lowering benefits and is recommended by the American Heart Association for patients with coronary heart disease and hypertriglyceridemia 2.
- Dietary supplements and prescription formulations containing EPA and DHA may lower TG levels, but may also increase LDL-C levels, although prescription icosapent ethyl (IPE) has been found to lower TG levels without increasing LDL-C levels 2.
- Omega-3 fatty acids have been found to have various health benefits, including reducing inflammation and promoting its resolution, suggesting a beneficial role in disease prevention and treatment 3.
Long-Term Use of Omega-3 Oil
- The long-term effects of omega-3 oil supplementation are still being studied, with some trials showing inconsistent results due to factors such as dose, timing, and duration of supplementation, as well as baseline omega-3 status and intake of other nutrients 3.
- Well-designed intervention studies are required to optimize the effects of DHA and EPA in specific patient populations and to develop more personalized strategies for their use 3.
- Some studies have found that long-chain omega-3 fatty acids, such as those found in fish oil, can have beneficial effects on cardiovascular health, including reducing blood lipids and triglycerides 4.
Safety and Efficacy of Omega-3 Oil
- Dietary supplements are not subject to the same government regulatory standards for safety, efficacy, and purity as prescription drugs, and may contain variable concentrations of EPA and DHA and possibly other contaminants 2.
- Prescription formulations of omega-3 fatty acids, such as OM-3-A EE and IPE, have been found to be safe and effective in lowering TG levels and other atherogenic markers 2.
- Microalgae oil, a vegetarian source of EPA and DHA, has been found to have comparable efficacies to fish oil in protecting against cardiovascular risk factors 5.