From the Guidelines
The most effective dose of omega-3 fatty acids for lowering apolipoprotein B levels is 4 grams per day of EPA, as evidenced by the REDUCE-IT trial 1. This dose has been shown to reduce the primary composite endpoint of cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina by 25% over a median follow-up of 4.9 years. Some key points to consider when using omega-3 fatty acids for this purpose include:
- The use of pharmaceutical-grade omega-3 supplements, which provide a consistent and high-quality source of EPA and DHA
- The importance of taking the supplement consistently for at least 8-12 weeks before expecting significant reductions in apolipoprotein B
- The potential for omega-3 fatty acids to be used as an adjunct to other lipid-lowering therapies, rather than as monotherapy, in individuals with very high apolipoprotein B levels
- The need for individuals on blood thinners to consult their healthcare provider before starting high-dose omega-3 supplements due to potential increased bleeding risk. The mechanism by which omega-3 fatty acids lower apolipoprotein B levels is thought to involve the reduction of hepatic VLDL production and the increase of clearance of triglyceride-rich lipoproteins, which subsequently leads to lower apolipoprotein B levels 1. Additionally, omega-3 fatty acids have anti-inflammatory effects that may contribute to cardiovascular benefits. It is worth noting that 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. However, the most recent and highest quality study, REDUCE-IT, suggests that a dose of 4 grams per day of EPA is the most effective for lowering apolipoprotein B levels 1.
From the Research
Omega-3 Dosage for Lowering Apolipoprotein B
- The beneficial dose of omega-3 for lowering apolipoprotein B has been investigated in several studies 2, 3, 4, 5, 6.
- A study published in 2015 found that a high dose of 3.4 g/d of EPA + DHA significantly decreased apoB and apoC-III levels in individuals with moderate hypertriglyceridemia, whereas a low dose of 0.85 g/d had no effect 3.
- Another study from 2019 compared the effects of EPA and DHA supplementation on serum triglycerides and found that DHA reduced blood triglycerides, while EPA had no effect 4.
- The exact mechanisms of action of EPA and DHA on apolipoprotein B-containing lipoproteins are not fully understood, but it is thought that they may reduce hepatic very-low-density lipoprotein (VLDL)-TG production and increase lipoprotein lipase activity 2.
- Overall, the available evidence suggests that a dose of 3.4 g/d of EPA + DHA may be beneficial for lowering apolipoprotein B levels, but more research is needed to confirm this finding 3, 4, 5.
Key Findings
- EPA and DHA have been shown to have beneficial effects on triglyceride levels and apolipoprotein B 2, 3, 4.
- The effects of EPA and DHA on apolipoprotein B may be influenced by genetics, such as APOE genotype 2.
- More research is needed to fully understand the mechanisms of action of EPA and DHA on apolipoprotein B-containing lipoproteins and to determine the optimal dose for therapeutic benefits 2, 3, 4, 5.