Omega-3 Supplementation Recommendations for Heart Disease and High Triglycerides
For patients with heart disease, 1 gram of EPA+DHA daily is recommended, while those with high triglycerides should take 2-4 grams of EPA+DHA daily under physician supervision. 1, 2
Dosage Recommendations by Condition
For Coronary Heart Disease:
- 1 gram of EPA+DHA (combined) daily for patients with documented coronary heart disease 1, 2
- This can be obtained from consuming oily fish twice weekly or through omega-3 supplements 1
- This dosage has been shown to significantly reduce cardiovascular events in randomized clinical trials 2
For Hypertriglyceridemia:
- 2-4 grams of EPA+DHA daily for patients with high triglyceride levels (>150 mg/dL) 1, 3
- This dosage can lower triglyceride levels by 20-40% 1, 3
- Patients taking more than 3 grams daily should do so under physician supervision due to potential bleeding risk 1
- At 4 g/day, EPA+DHA agents reduce triglycerides by ≥30% 3
Formulation Considerations
EPA+DHA Combination Products:
- Available as prescription medications (Lovaza®, Omtryg™, and generics) or over-the-counter supplements 4
- May increase LDL cholesterol levels, particularly in patients with very high triglycerides 3, 4
- Contain approximately 0.84 g of EPA+DHA in every 1-g capsule of prescription products 5
EPA-Only Products:
- Available as prescription medication (Vascepa®) 4
- Does not raise LDL cholesterol when used as monotherapy or with statins 3
- Shown to reduce major adverse cardiovascular events by 25% in high-risk patients on statins (REDUCE-IT trial) 3
Mechanisms of Action
- Decrease risk for arrhythmias, which can lead to sudden cardiac death 1
- Decrease triglyceride and remnant lipoprotein levels 1
- Decrease rate of growth of atherosclerotic plaque 1
- Improve endothelial function 1
- Inhibit diacylglycerol acyltransferase and increase plasma lipoprotein lipase activity 4
- Decrease hepatic lipogenesis and increase hepatic β-oxidation 4
Safety and Administration
- Well tolerated with primarily gastrointestinal adverse events 5, 4
- No significant drug interactions with other lipid-lowering medications such as statins and fibrates 6, 4
- For patients with triglyceride levels >500 mg/dL, omega-3 fatty acids should be used under physician supervision 1, 3
- Prescription omega-3 products ensure consistent quality and purity compared to over-the-counter supplements 5
Alternative Sources
- Fatty fish consumption (particularly mackerel, lake trout, herring, sardines, albacore tuna, and salmon) provides significant amounts of EPA and DHA 1
- Two servings of fish per week for persons with no history of coronary heart disease 6
- At least one serving of fish daily for those with known coronary heart disease 6
- Plant sources of alpha-linolenic acid (ALA) include tofu, soybeans, walnuts, flaxseeds, and canola oil, though ALA appears less potent than EPA and DHA 2
Cautions
- Some fish may contain environmental contaminants such as methylmercury and PCBs 1
- Pregnant/nursing women and children should be cautious about mercury exposure from fish consumption 2
- For middle-aged and older adults, the cardiovascular benefits of fish consumption outweigh potential risks 2
- Complete abstinence from alcohol is strongly recommended for patients with very high triglyceride levels to reduce pancreatitis risk 1