Omega-3 Fatty Acids and the Heart: New Evidence, More Questions-Harvard Health Blog


My patients usually ask me if I should try one supplement or another.My answer is usually ambiguous, because for most supplements, we just don’t have enough evidence to give a clear answer. This does not mean that a particular patient cannot benefit from a particular supplement. This just means that I don’t have standardized research to guide my recommendations. Sadly, this still applies to omega-3 fatty acid supplements. The results of studies on omega-3 supplements are inconsistent, which makes doctors and patients wonder what to do.

Omega-3 fatty acids showed advantages in the REDUCE-IT trial and were approved by the FDA

The two main omega-3 fatty acids are mainly found in fish and fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In the past 20 years, the American Heart Association (AHA) has recommended the use of Omega-3 in fish and fish oil to reduce cardiovascular events in people who already have cardiovascular disease (CVD), such as heart attack or stroke.I have got Write about And firmly advocates obtaining omega-3 through diet and sometimes through the use of supplements.

In the past year, based on evidence of cardiovascular disease, I have prescribed omega-3s sold under the Vascepa brand to patients with high CVD risk. Vascepa contains purified EPA and its use is based on good clinical data from the United States REDUCE-IT trial. The study recruited 8,000 patients with high risk of cardiovascular disease and high blood triglyceride levels. They assigned half of the study participants to receive 2 grams of Vascepa twice a day, and assigned other participants a placebo (a pill filled with mineral oil). The results show that Vascepa is better than placebo. Vascepa reduces the level of triglycerides in the blood, but more importantly, it reduces the number of heart attacks and strokes, requires heart stent surgery to open blocked arteries and reduce deaths.

Follow-up Meta-analysisIncluding data from more than 10 studies, it was found that 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 who have CVD or are at high risk of CVD.

The STRENGTH trial casts doubt on the benefits of omega-3

But a recent study raised some questions.This Strength test, Published on Jama, Studied another formulation of omega-3 fish oil-a combination of EPA and DHA-to see if it can also reduce the risk of cardiovascular disease. The study enrolled more than 13,000 patients who were randomly assigned to receive an EPA/DHA combination drug or a placebo (a drug filled with corn oil). Because an interim analysis showed no difference between the two treatment groups, the trial was terminated early.

We are not sure why the REDUCE-IT trial showed benefits from omega-3, while the STRENGTH trial did not. One possibility is that the different results are due to the different drugs studied. REDUCE-IT has studied the purified formula of high-dose EPA, thereby increasing the content of EPA.This is similar to Another trial, Also found that pure EPA can reduce the risk of cardiac events. The STRENGTH test tested the combination of EPA and DHA. There are no large studies evaluating the effect of purified DHA alone on cardiovascular outcomes, which makes us wonder whether DHA will offset the benefits of EPA.

Where are we standing?

Back to patients who want to know if they should take omega-3 supplements. Considering today’s data, I suggest you use pure EPA supplements, or the EPA content in them is higher than the EPA content of DHA. But don’t stop there.Diet is good for heart health, exercise regularly and pursue Other lifestyle changes It has been proven to be beneficial to cardiovascular health. At the same time, my colleagues and I are waiting for more precise data on the effectiveness of omega-3 fish oil, who may benefit the most.



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