Prescription omega-3 meds—but not unregulated fish oils—lower triglycerides

An August 19 science advisory from the American Heart Association states that a 4-gram dose of prescription omega-3 fatty acid medication can greatly reduce people’s triglyceride levels, but patients likely won’t see the same results if they turn to popular—yet unproven—fish oil therapies.

Ann Skulas-Ray, PhD, and co-authors of the advisory reviewed evidence from 17 randomized controlled clinical trials on high triglyceride levels, finding in the process that 4 grams daily of either of two approved omega-3 drugs could effectively and safely lower lipid levels in patients with a high triglyceride count. Around a quarter of adults in the U.S. have triglyceride levels of around 150 mg/dL—right on the border of what’s considered high.

To date, the FDA has approved just two prescription omega-3 fatty acid therapies for use in the U.S., and they’re only indicated for patients with “very high” triglyceride levels above 500 mg/dL. One medication combines two types of fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), while the other uses EPA alone. Skulas-Ray and her team didn’t provide a recommendation for one drug over the other since there haven’t been any head-to-head comparisons of the two.

Still, the medicines have shown efficacy. In the recent REDUCE-IT trial, the EPA-only drug combined with a statin resulted in a 25% reduction in major adverse CV events among people with high triglycerides (200 to 499 mg/dL). In their review, Skulas-Ray et al. found most individuals with high triglycerides would benefit from prescription doses of omega-3 fatty acids, with both the EPA/DHA and EPA formulas resulting in a 20% to 30% reduction in triglyceride levels.

The panel also found that, contrary to popular belief, the EPA/DHA combo drug doesn’t increase LDL-cholesterol among the majority of people with high triglyceride levels. Still, when the medication is administered to those with very high triglyceride levels, there’s a possibility LDL-C could still increase.

The advisory’s authors said it’s important to manage lifestyle factors like physical activity, weight loss and diet to control their triglyceride levels. Some foods, like fish, are also a good source of omega-3 fatty acids, but Skulas-Ray and her team warned consumers against relying on fish oil supplements for a boost of omega-3.

“Dietary supplements containing omega-3 fatty acids are not regulated by the FDA,” Skulas-Ray said in a release. “They should not be used in place of prescription medication for the long-term management of high triglycerides.”