From the Guidelines
For adults with high triglycerides, a daily omega-3 dose of 4 grams of EPA and DHA combined is recommended, as stated in the 2021 ACC expert consensus decision pathway 1. This dose is specifically recommended for patients with triglyceride levels of 500 to 999 mg/dL, and it requires pharmacotherapy to achieve a consistent dose on an ongoing basis. The American College of Cardiology recommends consuming at least 2 or more servings of fish/seafood per week, with a focus on fatty fish such as salmon, rainbow trout, and tuna, for patients with triglyceride levels of 200 to 499 mg/dL and 500 to 999 mg/dL 1. However, for patients who need to limit their fat intake, lean fish or seafood such as cod, tilapia, haddock, flounder, and shrimp are recommended. It's essential to prioritize fresh or frozen fish or fish packaged without sodium and avoid canned, smoked, or cured fish/seafood that are high in sodium. While the American Heart Association recommends 2 to 4 g of EPA plus DHA per day for patients who need to lower their triglyceride level 1, the most recent and highest quality study, the 2021 ACC expert consensus decision pathway, recommends a dose of 4 grams per day of EPA + DHA for patients with elevated triglycerides 1. Key points to consider when taking omega-3 supplements include:
- Taking them with meals to improve absorption and reduce potential side effects
- Monitoring triglyceride levels regularly to assess effectiveness
- Combining supplementation with dietary changes, regular exercise, weight management, and limiting alcohol consumption for optimal triglyceride reduction. The mechanism of action of omega-3 fatty acids involves decreasing the liver's production of triglycerides and VLDL cholesterol while promoting the breakdown of fatty acids. Overall, the recommended dose of 4 grams of EPA and DHA combined per day, as stated in the 2021 ACC expert consensus decision pathway 1, should be prioritized for adults with high triglycerides.
From the FDA Drug Label
The daily dose of omega-3-acid ethyl esters capsules is 4 grams per day. The daily dose may be taken as a single 4-gram dose (4 capsules) or as two 2-gram doses (2 capsules given twice daily). Omega-3-acid ethyl esters 4 grams per day were assessed in 2 randomized, placebo-controlled, double-blind, parallel-group trials of 84 adult subjects (42 on omega-3-acid ethyl esters, 42 on placebo) with very high triglyceride levels
The recommended omega-3 dose for an adult with high triglycerides is 4 grams per day 2 2.
- This dose can be taken as a single 4-gram dose or divided into two 2-gram doses per day.
- It is essential to monitor patients, as treatment with omega-3-acid ethyl esters may result in elevations in LDL-C and non-HDL-C in some individuals 2.
From the Research
Omega-3 Fatty Acid Dosage for Adults with High Triglycerides
- The recommended dose of omega-3 fatty acids for adults with high triglycerides is 2-4 g/d, as stated by the American Heart Association in 2002 3.
- Prescription omega-3 fatty acid products, such as omega-3-acid ethyl esters, omega-3-carboxylic acids, and icosapent ethyl, are approved for the treatment of severe hypertriglyceridemia and have been shown to effectively lower triglyceride levels 4, 5.
- A dose of 4 g/d of omega-3 fatty acids, particularly EPA-only or EPA+DHA, has been found to reduce triglycerides by ≥30% and decrease non-high-density lipoprotein cholesterol and apolipoprotein B, indicating a reduction in total atherogenic lipoproteins 3.
- Icosapent ethyl, an EPA-only formulation, has been shown to lower triglyceride levels without significantly affecting serum low-density lipoprotein cholesterol, making it a potential option for patients with atherosclerosis 6, 7.
Key Considerations
- The choice of omega-3 fatty acid product and dosage should be based on individual patient needs and medical history, as well as the potential benefits and risks of each formulation 4, 5.
- Patients with severe hypertriglyceridemia (≥500 mg/dL) may require higher doses of omega-3 fatty acids, such as 4 g/d, to achieve significant reductions in triglyceride levels 3.
- Omega-3 fatty acid therapy may be used as monotherapy or in combination with other lipid-lowering agents, such as statins, to achieve optimal lipid profiles and reduce cardiovascular risk 3, 6.