Omega-3 fatty acids and the center: New proof, extra questions – Harvard Well being Weblog

omega-3 fish oil capsules in heart shaped dish

My sufferers generally ask me whether or not they need to strive one complement or one other. Typically my reply is equivocal, as a result of for many dietary supplements we simply don’t have sufficient proof to present a particular reply. This doesn’t imply {that a} specific affected person couldn’t profit from a selected complement; it simply means I don’t have standardized analysis to information my suggestions. Sadly, this stays true of omega-3 fatty acid dietary supplements. The outcomes of research taking a look at omega-3 dietary supplements have been inconsistent, and have left each physicians and sufferers questioning what to do.

Omega-3 fatty acids present profit in REDUCE-IT trial and win FDA approval

Two principal omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are discovered primarily in fish and fish oil. Omega-3s from fish and fish oil have been advisable by the American Coronary heart Affiliation (AHA) for the previous 20 years to scale back cardiovascular occasions, like coronary heart assault or stroke, in individuals who have already got heart problems (CVD). I’ve written about and been a robust advocate of getting omega-3s by food plan, and generally by the usage of dietary supplements.

Over the previous 12 months I’ve prescribed an omega-3, bought beneath the model title Vascepa, to my sufferers who’re at excessive threat for CVD, based mostly on proof of cardiovascular advantages. Vascepa comprises purified EPA, and its use is predicated on good medical knowledge from the REDUCE-IT trial. This research enrolled over 8,000 sufferers with elevated cardiovascular threat and excessive blood triglyceride ranges. They assigned half of the research contributors to obtain 2 grams of Vascepa twice a day, and assigned the opposite contributors a placebo (a tablet full of mineral oil). The outcomes confirmed a major advantage of Vascepa over the placebo. Vascepa lowered blood triglyceride ranges, however extra importantly, it lowered the variety of coronary heart assaults and strokes, the necessity for a coronary heart stenting process to open clogged arteries, and demise.

A subsequent meta-analysis, which included knowledge from over 10 research, discovered fish oil omega‐3 dietary supplements lowered threat for coronary heart assault and demise from coronary coronary heart illness.

In December 2020, the FDA authorized the usage of Vascepa to scale back the chance of cardiovascular occasions in sure sufferers with, or at excessive threat for, CVD.

STRENGTH trial casts some doubt on omega-3 advantages

However a current research has raised some questions. The STRENGTH trial, printed in JAMA, checked out a distinct formulation of omega-3 fish oil — a mixture of EPA and DHA — to see if it will additionally cut back cardiovascular threat. This research enrolled over 13,000 sufferers who have been randomized to obtain both the EPA/DHA mixture tablet or the placebo (a tablet full of corn oil). The trial was terminated early as a consequence of an interim evaluation revealing no distinction between the 2 therapy teams.

We don’t know for sure why the REDUCE-IT trial confirmed a profit from omega-3s whereas the STRENGTH trial didn’t. One risk is that the totally different outcomes are because of the totally different medication studied. REDUCE-IT studied a purified formulation of high-dose EPA, which resulted in larger EPA ranges. This was much like the outcomes of one other trial, which additionally discovered that pure EPA lowered the chance of cardiac occasions. The STRENGTH trial examined a mixture of EPA and DHA. No massive research has ever evaluated the results on cardiovascular outcomes of purified DHA alone, leaving us to wonder if DHA may counteract the advantages of EPA.

The place will we stand?

Again to my sufferers who wish to know if they need to be taking an omega-3 complement. With the supply of right this moment’s knowledge, I might suggest a pure EPA complement, or one which comprises extra EPA than DHA. However don’t cease there. Eat a heart-healthy food plan, get common train, and pursue different life-style modifications which have confirmed advantages for cardiovascular well being. Within the meantime, my colleagues and I await extra definitive knowledge on the utility of omega-3 fish oil, and who may profit essentially the most.

What do you think?

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