22 Aug AHA Issues Guidance on Use of Omega-3 Fatty Acids for High Triglycerides
MedicalResearch.com Interview with:
Ann Skulas–Ray, PhD.
Assistant Professor, Department of Nutritional Sciences
University of Arizona
MedicalResearch.com: What is the background for this study?
Response: The prior guidance from the AHA regarding omega-3 fatty acids and high triglycerides was published in 2002, prior to the availability of prescription omega-3 concentrates and results from many of the clinical studies we were able to review. Our advisory was able to address questions such as dose and concomitant use of statin therapy. Another unique feature of our advisory is that we evaluated studies of the effects of omega-3 fatty acids in people with triglycerides (TG) > or = 500 mg/dL and 200-499 mg/dL separately, so we were able to see patterns relating to dose of omega-3 fatty acids and baseline triglyceride values. We came to separate conclusions for populations above and below TG of 500 mg/dL and concluded that 4 g/d was most effective. In contrast, the 2002 guidance recommended 2-4 g/d EPA + DHA under a physician’s care for high triglycerides.
MedicalResearch.com: What are the main findings?
Response: When we began writing this advisory, the results of REDUCE-IT were not yet available. We delayed publication in order to include results of this trial. Omega-3 fatty acids are not always part of the discussion regarding triglyceride management and this was likely due to the lack of studies evaluating effects prescription dosing of omega-3 fatty acids on hard endpoints in a population with elevated triglycerides. The results of REDUCE-IT changed that.
MedicalResearch.com: What should readers take away from your report?
Response: Omega-3 fatty acids are a safe and effective pharmacological option for reducing elevated triglycerides when administered at prescription doses. The degree of response will be determined by the severity of an individual’s TG elevation prior to treatment. Measurement of TG is highly variable day-to-day so determination of response should not be based on a single measurement. We have an appendix in the advisory relating to the practical aspects of monitoring lipids and lipoprotein responses.
High triglycerides (HTG, 200-499 mg/dL) are relatively common. Prescription omega-3 fatty acids (4 g/d) effectively reduce triglycerides in people with HTG and do not increase LDL cholesterol. In a large clinical trial of people with HTG, this dose also resulted in a 25% reduction in major adverse cardiovascular events (such as heart attacks and strokes.)
One of the surprising findings of this analysis is that the prescription omega-3 fatty acids containing DHA did not increase LDL “bad” cholesterol in studies of people with TG < 500 mg/dL. Prior reviews on this topic did not stratify studies based on the patient population, i.e. TG < 500 vs. TG > or = 500 mg/dL. Both the dose of omega-3 fatty acids and the degree of TG elevation are key factors for how a patient will respond to prescription omega-3 fatty acids.
Triglycerides fluctuate quite a bit day-to-day, so it’s important not to draw too much inference from a single measurement. In my research experience, it is common to observe fasting triglycerides and calculated LDL fluctuate quite a bit, even when measures are obtained on consecutive days following a 12 hour fast.
People with elevated triglycerides are also likely to be on statin therapy as “first line” treatment. We concluded that omega-3 fatty acids were equally effective regardless of whether people were taking statins.
Prescription omega-3 fatty acids have been shown to be safe and well-tolerated, even at the prescription doses used to effectively manage high triglycerides. We did not find evidence for concerning interactions with other drugs classes, and they can be safely combined with statin therapy to improve management of dyslipidemia and associated cardiovascular risk.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: I would love to conduct a head-to-head trial comparing the effects of the different prescription agents on lipids, lipoproteins, and other markers of cardiovascular risk.
MedicalResearch.com: Is there anything else you would like to add?
Response: No financial disclosures. I have conducted clinical research studies on this topic.
Skulas-Ray AC, et al “Omega-3 fatty acids for the management of hypertriglyceridemia: a science advisory from the American Heart Association” Circulation 2019; DOI: 10.1161/CIR.0000000000000709.
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