Ann C. Skulas-Ray, Peter W.F. Wilson, William S. Harris, Eliot A. Brinton, Penny M. Kris-Etherton, Chesney K. Richter, Terry A. Jacobson, Mary B. Engler, Michael Miller, Jennifer G. Robinson, Conrad B. Blum, Delfin Rodriguez-Leyva, Sarah D. de Ferranti, Francine K. Welty, and On behalf of the American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology
Originally published : 19 Aug 2019 https://doi.org/10.1161/CIR.0000000000000709
Summary and Conclusions
Prescription n-3 FAs at the FDA-approved dose of 4 g/d are safe and generally well tolerated. At this dose, triglyceride lowering of ≥30% has been reported in clinical trials of subjects with VHTG (triglycerides ≥500 mg/dL), in whom these agents are FDA approved.
In VHTG, the goal of therapy is to reduce triglyceride levels to <500 mg/dL and to lessen the risk of pancreatitis, although this may not be achieved with n-3 FA monotherapy, so additional triglyceride-lowering pharmacological treatment may be indicated. In the context of HTG (triglycerides, 200–499 mg/dL), 4 g/d prescription n-3 FA effectively lowers triglycerides by ≈20% to 30% and does not significantly increase LDL-C.
In all patients, established recommendations for diet and lifestyle should also be followed.11 In the largest studies of 4 g/d EPA+DHA or EPA-only as adjuncts to statin therapy, non–HDL-C and apo B were modestly decreased, suggesting reductions in total atherogenic lipoproteins.
Use of n-3 FA may be accompanied by mild gastrointestinal complaints (such as “fishy burps” or nausea), but taking n-3 FA with meals may reduce gastrointestinal side effects and improve absorption of O3AEE and IPE. In clinical trials completed to date, <5% of subjects have discontinued omega-3 agents because of side effects.
The triglyceride-lowering efficacy and generally excellent safety and tolerability of n-3 FAs make them valuable tools for healthcare providers. The use of n-3 FAs (4 g/d) for improving ASCVD risk in patients with HTG is supported by a 25% reduction in major adverse cardiovascular end points in REDUCE-IT, a randomized placebo-controlled trial of EPA-only in high-risk patients on statin therapy.
Results from the STRENGTH trial, a randomized placebo-controlled cardiovascular outcomes trial of 4 g/d prescription EPA+DHA in patients with HTG and low HDL-C on statins, are anticipated in 2020. We conclude that prescription n-3 FAs, whether EPA+DHA or EPA-only, at a dose of 4 g/d, are clinically useful for reducing triglycerides, after any underlying causes are addressed and diet and lifestyle strategies are implemented, either as monotherapy or as an adjunct to other triglyceride-lowering therapies
ChooseLife Notes : It is well established that EPA and DHA are both readily created by ALA, so similar results should be expected from Flax Oil.