Prescription omega-3 fatty acid medication reduces triglyceride levels by 20-30 percent among the majority of people who require treatment for high triglyceride levels, according to a science advisory from the American Heart Association.
Triglycerides are fats that circulate in the blood. Some studies have shown that elevated levels of triglycerides (above 200 mg/dL) can lead to atherosclerosis (narrowing of the arteries) which increases the risk of heart attack and stroke. In addition to cardiovascular risk, very high levels of triglycerides (above 500 mg/dL) can also cause pancreatitis, an inflammation of the pancreas.
"From our review of the evidence from 17 randomized, controlled clinical trials on high triglyceride levels, we concluded that treatment with 4 grams daily of any of the available prescription choices is effective and can be used safely in conjunction with statin medicines that lower cholesterol," said Ann Skulas-Ray, Ph.D., an author of the new science advisory published in the American Heart Association journal Circulation.
There are two prescription omega-3 fatty acid medications available. One combines two types of fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). The other medication provides EPA only. Since there have been no head-to-head comparisons of the two different formulations at prescription dosing, the advisory does not recommend one over the other.
Skulas-Ray points out that people with high triglyceride levels should not try to treat the condition themselves with non-prescription, omega-3 fatty acid fish oil supplements.
"Dietary supplements containing omega-3 fatty acids are not regulated by the FDA. They should not be used in place of prescription medication for the long-term management of high triglycerides," said Skulas-Ray, who is an assistant professor in the Department of Nutritional Sciences at the University of Arizona in Tucson. In a 2017 science advisory, the American Heart Association noted that there is a lack of scientific research to support clinical use of omega-3 fatty acid supplements to prevent heart disease in the general population.
The effective dose for prescription omega-3 fatty acids is four grams per day taken with food. Currently, the FDA has approved prescription omega-3 fatty acid medications only for treating very high triglyceride levels above 500 mg/dL.
Healthy lifestyle choices, such as getting regular physical activity, losing weight, avoiding sugar and refined carbohydrates, limiting alcohol as well as choosing healthier fats from plants in place of saturated fats can help reduce triglycerides. It is also important to treat or eliminate conditions such as poorly controlled type 2 diabetes, hypothyroidism and obesity that may contribute to high triglyceride levels before turning to medication.
Fish is a good source of omega-3 fatty acids, and the American Heart Association recommends eating fatty fish - such as salmon, mackerel, herring and albacore tuna - at least two times per week.
Ann C. Skulas-Ray , Peter W.F. Wilson , William S. Harris , Eliot A. Brinton , Penny M. Kris-Etherton , Chesney K. Richter , Terry A. Jacobson , Mary B. Engler , Michael Miller , Jennifer G. Robinson , Conrad B. Blum , Delfin Rodriguez-Leyva , Sarah D. de Ferranti , and Francine K. Welty (2019) Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association. Circulation
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