My sufferers generally ask me whether or not they need to attempt 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 provide a particular reply. This doesn’t imply {that a} explicit affected person couldn’t profit from a particular 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 most important 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 beneficial 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 powerful advocate of getting omega-3s via eating regimen, and generally via using dietary supplements.
Over the previous 12 months I’ve prescribed an omega-3, offered underneath the model title Vascepa, to my sufferers who’re at excessive threat for CVD, primarily based on proof of cardiovascular advantages. Vascepa comprises purified EPA, and its use is predicated on good medical information from the REDUCE-IT trial. This examine enrolled over 8,000 sufferers with elevated cardiovascular threat and excessive blood triglyceride ranges. They assigned half of the examine members to obtain 2 grams of Vascepa twice a day, and assigned the opposite members a placebo (a capsule stuffed with mineral oil). The outcomes confirmed a big good thing about 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 loss of life.
A subsequent meta-analysis, which included information from over 10 research, discovered fish oil omega‐3 dietary supplements lowered threat for coronary heart assault and loss of life from coronary coronary heart illness.
In December 2020, the FDA accepted using 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 latest examine has raised some questions. The STRENGTH trial, revealed in JAMA, checked out a special formulation of omega-3 fish oil — a mix of EPA and DHA — to see if it will additionally cut back cardiovascular threat. This examine enrolled over 13,000 sufferers who had been randomized to obtain both the EPA/DHA mixture capsule or the placebo (a capsule stuffed with 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 chance is that the completely different outcomes are as a result of completely different medication studied. REDUCE-IT studied a purified formulation of high-dose EPA, which resulted in increased EPA ranges. This was just like the outcomes of another trial, which additionally discovered that pure EPA lowered the chance of cardiac occasions. The STRENGTH trial examined a mix of EPA and DHA. No giant examine has ever evaluated the consequences on cardiovascular outcomes of purified DHA alone, leaving us to wonder if DHA may counteract the advantages of EPA.
The place can we stand?
Again to my sufferers who wish to know if they need to be taking an omega-3 complement. With the provision of immediately’s information, I’d suggest a pure EPA complement, or one which comprises extra EPA than DHA. However don’t cease there. Eat a heart-healthy eating regimen, get common train, and pursue other lifestyle changes which have confirmed advantages for cardiovascular well being. Within the meantime, my colleagues and I look forward to extra definitive information on the utility of omega-3 fish oil, and who may profit probably the most.
