Siddhima Pathak

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Prescription omega-3 fatty acids are an "effective and safe option" to cut down triglycerides, according to a science advisory released by the American Heart Association (AHA).

However, over-the-counter omega-3 supplements are not reviewed or approved by the FDA and should not be used in place of prescription medication for the long-term management of high triglycerides, cautioned writing group chair Ann Skulas-Ray, PhD, of the University of Arizona, Tucson, in a press release.

Prescription omega-3 fatty acids "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," her group concluded.

Fish oil products containing eicosapentaenoic acid (EPA) and/or docosahexaenoic acid (DHA) taken at that dose have been shown to reduce triglyceride levels by at least 30% in patients with triglycerides of 500 mg/dL or greater, according to the statement published online in Circulation.

EPA-only formulations did not raise LDL cholesterol in this group, whereas combination EPA-DHA did, authors noted.

Among people with hypertriglyceridemia in the 200-499 mg/dL range, the 4-g/day dose of prescription omega-3 fatty acids lowered triglycerides by 20% to 30% without significantly increasing LDL cholesterol.

Nevertheless, these supplements may be accompanied by mild gastrointestinal complaints or nausea, so the AHA document recommended taking them with meals.

Available prescription omega-3 fatty acids include Lovaza (EPA+DHA) and Vascepa (EPA only), the latter of which was shown to reduce major adverse cardiovascular events by 25% over 5 years among statin-takers in the REDUCE-IT trial.

Next year, the STRENGTH trial is expected to shed light on the cardiovascular outcomes of prescription EPA+DHA in patients with high triglycerides and low HDL cholesterol on statins, Skulas-Ray's group noted.

Another question is whether omega-3 fatty acid supplementation works in children and adolescents: Negative findings have been reported from trials using lower doses or including smaller samples that in some cases included minors with only mildly elevated triglycerides.

The AHA statement said the supplements are "apparently safe," but larger trials testing at least 3 g/d EPA+DHA in children with 200–499 mg/dL triglycerides are needed to better establish efficacy, safety, and tolerability in this population.

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From the same section of the PEP8:

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