Omega‐3 fatty acids for the prevention of atherosclerotic cardiovascular disease. Issue 12 (30th August 2021) - Barry, Arden R.
Abstract: Marine‐derived omega‐3 fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are a type of polyunsaturated fatty acids with many purported beneficial health effects including the prevention of atherosclerotic cardiovascular disease (ASCVD) events. Omega‐3 fatty acid intake may be supplemented via dietary sources, as well as prescription or non‐prescription products. Omega‐3 fatty acids have been shown to reduce serum triglycerides, but there remains ongoing debate regarding the effect of omega‐3 fatty acids on major adverse cardiovascular events in patients with established, or at risk of, ASCVD. Recent evidence from randomized, placebo‐controlled trials has demonstrated that low‐dose (1 g daily or less) omega‐3 fatty acids (DHA and EPA) do not reduce cardiovascular events or death in patients with or without established ASCVD. Contrarily, the REDUCE‐IT trial demonstrated that a purified form of EPA ethyl esters (icosapent ethyl) at 4 g daily reduced cardiovascular events and death in patients with ASCVD (or diabetes and multiple cardiovascular risk factors) and elevated triglycerides on background statin therapy. However, 4 g daily of omega‐3 carboxylic acids (DHA and EPA) did not show a cardiovascular benefit in the STRENGTH trial, which enrolled a similar population. The explanation for this observed discrepancy remains a source of contention and discourse. For now, icosapent ethyl has the most compelling evidence to support a cardiovascular benefit and should be considered in select patients who meet the REDUCE‐IT criteria. Furthermore, alternative versions of omega‐3 fatty acids should not be considered equivalent to icosapent ethyl. Patients taking an omega‐3 fatty acid supplement should be monitored for potential adverse effects, including gastrointestinal disorders or bleeding, in addition to a possible increased risk of atrial fibrillation.