Omega-3 fatty acids and the center: New proof, extra questions

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My sufferers generally ask me whether or not they need to attempt one complement or one other. Typically my reply is equivocal, as a result of for many dietary supplements we simply don’t have sufficient proof to offer a particular reply. This doesn’t imply {that a} explicit affected person couldn’t profit from a particular complement; it simply means I don’t have standardized analysis to information my suggestions. Sadly, this stays true of omega-3 fatty acid dietary supplements. The outcomes of research omega-3 dietary supplements have been inconsistent, and have left each physicians and sufferers questioning what to do.

Omega-3 fatty acids present profit in REDUCE-IT trial and win FDA approval

Two essential omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are discovered primarily in fish and fish oil. Omega-3s from fish and fish oil have been beneficial by the American Coronary heart Affiliation (AHA) for the previous 20 years to cut back cardiovascular occasions, like coronary heart assault or stroke, in individuals who have already got heart problems (CVD). I’ve written about and been a robust advocate of getting omega-3s by means of weight loss plan, and generally by means of using dietary supplements.

Over the previous 12 months I’ve prescribed an omega-3, bought underneath the model identify Vascepa, to my sufferers who’re at excessive danger for CVD, based mostly on proof of cardiovascular advantages. Vascepa comprises purified EPA, and its use relies on good medical knowledge from the REDUCE-IT trial. This research enrolled over 8,000 sufferers with elevated cardiovascular danger and excessive blood triglyceride ranges. They assigned half of the research contributors to obtain 2 grams of Vascepa twice a day, and assigned the opposite contributors a placebo (a tablet stuffed with mineral oil). The outcomes confirmed a major good thing about Vascepa over the placebo. Vascepa decreased blood triglyceride ranges, however extra importantly, it decreased the variety of coronary heart assaults and strokes, the necessity for a coronary heart stenting process to open clogged arteries, and demise.

A subsequent meta-analysis, which included knowledge from over 10 research, discovered fish oil omega‐3 dietary supplements lowered danger for coronary heart assault and demise from coronary coronary heart illness.

In December 2020, the FDA permitted using Vascepa to cut back the chance of cardiovascular occasions in sure sufferers with, or at excessive danger for, CVD.

STRENGTH trial casts some doubt on omega-3 advantages

However a current research has raised some questions. The STRENGTH trial, printed in JAMA, checked out a special formulation of omega-3 fish oil — a mixture of EPA and DHA — to see if it could additionally scale back cardiovascular danger. This research enrolled over 13,000 sufferers who have been randomized to obtain both the EPA/DHA mixture tablet or the placebo (a tablet stuffed with corn oil). The trial was terminated early as a result of an interim evaluation revealing no distinction between the 2 remedy teams.

We don’t know for sure why the REDUCE-IT trial confirmed a profit from omega-3s whereas the STRENGTH trial didn’t. One chance is that the completely different outcomes are because of the completely different medicine studied. REDUCE-IT studied a purified formulation of high-dose EPA, which resulted in greater EPA ranges. This was much like the outcomes of another trial, which additionally discovered that pure EPA decreased the chance of cardiac occasions. The STRENGTH trial examined a mixture of EPA and DHA. No giant research has ever evaluated the results on cardiovascular outcomes of purified DHA alone, leaving us to wonder if DHA would possibly counteract the advantages of EPA.

The place will we stand?

Again to my sufferers who wish to know if they need to be taking an omega-3 complement. With the supply of at this time’s knowledge, I might suggest a pure EPA complement, or one which comprises extra EPA than DHA. However don’t cease there. Eat a heart-healthy weight loss plan, get common train, and pursue other lifestyle changes which have confirmed advantages for cardiovascular well being. Within the meantime, my colleagues and I watch for extra definitive knowledge on the utility of omega-3 fish oil, and who would possibly profit essentially the most.

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