Omega-3 fatty acids and the heart: new evidence, more questions – Harvard Health Blog
My patients usually ask me if they should try one supplement or the other. Often my answer is equivocal because in most supplements we don’t have enough evidence to give an accurate answer. This does not mean that a particular patient cannot extract specific supplements; it means I don’t have standardized research to guide my recommendations. Unfortunately, this remains true with omega-3 fatty acid supplements. The results of research examining omega-3 supplements are inconsistent, leaving both doctors and patients thinking about what to do.
Omega-3 fatty acids benefit from REDUCE-IT test and get FDA approval
Two major omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are found mainly in fish and fish oil. Omega-3s in fish and fish oil have been recommended by the American Heart Association (AHA) for the past 20 years to reduce cardiovascular events, such as heart attacks or strokes, in people who already have cardiovascular disease (CVD). Badut written about and I have been a strong advocate of omega-3s through diet and sometimes supplement use.
Last year I prescribed an omega-3, sold under the brand name Vascepa, to patients at high risk for CVD, based on evidence of cardiovascular benefits. Vaspeca has purified EPA and its use is based on good clinical data REDUCE IT test. This study reported more than 8,000 patients with high cardiovascular risk and high blood triglyceride levels. Half of the study participants were assigned to receive 2 grams of Vascepa per day and the remaining participants were assigned a placebo (a pill filled with mineral oils). The results showed a significant benefit for Vaspeca over placebo. Vascepa reduced the level of triglycerides in the blood, but more importantly, it reduced the number of heart attacks and strokes, the need for a heart stenting procedure to open clogged arteries and death.
One of the following meta-analysisIt collected data from more than 10 studies. Fish oil omega-3 supplements reduced the risk of heart attack and death from coronary heart disease.
In December 2020, the FDA approved the use of Vascepa to reduce the risk of cardiovascular events in certain patients with or at high risk for EKM.
The current lawsuit raises questions about the benefits of omega-3
But a recent study has raised some questions. The STRENGTH TRIALpublished in JAMAHe looked at another formulation of omega-3 fish oil – a combination of EPA and DHA – to see if it would also reduce cardiovascular risk. This study enrolled more than 13,000 patients who were randomized to receive an EPA / DHA combination pill or placebo (a pill filled with corn oil). The trial ended early because the difference between the two treatment groups revealed a preliminary analysis.
We are not sure why the REDUCE-IT test showed the benefit of omega-3, while the INDARGTH test did not. One possibility is that the different results are due to the different drugs studied. REDUCE-IT examined a high-dose purified EPA formulation, which resulted in higher EPA levels. The results were similar another trial, which also found that pure EPA reduced the risk of heart events. The STRENGTH test tested a combination of EPA and DHA. No major study has ever evaluated the cardiovascular outcomes of purified DHA, which raises the question of whether DHA can address the benefits of EPA.
Where are we?
Return to patients who want to know if they need to take an omega-3 supplement. With today’s data availability, I would recommend one with a pure EPA supplement or one that has more EPA than DHA. But don’t stop there. Eat a healthy heart diet, exercise and follow other lifestyle changes that it has cardiovascular health benefits. In the meantime, my colleagues and I will be waiting for the final data on the usefulness of omega-3 fish oil and who can benefit the most.