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 strive one complement or one other. Usually 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 selected 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 foremost 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 really helpful 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 powerful advocate of getting omega-3s via weight loss program, and typically via using dietary supplements.

Over the previous yr I’ve prescribed an omega-3, offered below the model identify Vascepa, to my sufferers who’re at excessive danger for CVD, primarily based on proof of cardiovascular advantages. Vascepa incorporates purified EPA, and its use relies on good scientific information 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 capsule full of mineral oil). The outcomes confirmed a major good thing about Vascepa over the placebo. Vascepa diminished blood triglyceride ranges, however extra importantly, it diminished the variety of coronary heart assaults and strokes, the necessity for a coronary heart stenting process to open clogged arteries, and dying.

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

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

STRENGTH trial casts some doubt on omega-3 advantages

However a latest research has raised some questions. The STRENGTH trial, printed in JAMA, checked out a distinct formulation of omega-3 fish oil — a mixture of EPA and DHA — to see if it will additionally cut back cardiovascular danger. This research enrolled over 13,000 sufferers who had been randomized to obtain both the EPA/DHA mixture capsule or the placebo (a capsule full of corn oil). The trial was terminated early because 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 as a result of completely different medication studied. REDUCE-IT studied a purified formulation of high-dose EPA, which resulted in larger EPA ranges. This was much like the outcomes of another trial, which additionally discovered that pure EPA diminished the danger of cardiac occasions. The STRENGTH trial examined a mixture of EPA and DHA. No massive research has ever evaluated the consequences on cardiovascular outcomes of purified DHA alone, leaving us to wonder if DHA may counteract the advantages of EPA.

The place can we stand?

Again to my sufferers who wish to know if they need to be taking an omega-3 complement. With the provision of right this moment’s information, I might suggest a pure EPA complement, or one which incorporates extra EPA than DHA. However don’t cease there. Eat a heart-healthy weight loss program, get common train, and pursue other lifestyle changes which have confirmed advantages for cardiovascular well being. Within the meantime, my colleagues and I anticipate extra definitive information on the utility of omega-3 fish oil, and who may profit probably the most.

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