Top Things to Know: Omega-3 Fatty Acids for the Management of Hypertriglyceridemia
Published: August 19, 2019
- Elevated plasma triglycerides (TG) are due to an excess of TG-rich lipoproteins of several different types, most commonly of very low-density lipoproteins (VLDL).
- Hypertriglyceridemia (HTG, TG 200-499mg/dL) and very high triglycerides (VHTG, TG ≥ 500mg/dL) are becoming increasingly prevalent in the US, likely driven by growing rates of obesity and diabetes mellitus.
- This advisory summarizes available clinical evidence related to the effects of omega-3 fatty acids (n-3 FA) on plasma concentrations of TG and other lipids and lipoproteins in individuals with elevated TGs.
- Dietary supplements containing n-3 FA are widely available, in a variety of chemical forms. However, because these supplements are neither reviewed nor approved by the FDA, they are not indicated for TG-lowering in patients with any degree of TG elevation.
- Prior to initiating prescription TG-lowering therapy, reversible secondary causes of HTG (such as hypothyroidism or poorly controlled type 2 diabetes mellitus) should be identified and treated.
- Additionally, dietary factors that are established causes of TG elevations, such as excessive alcohol or sugar intake (or excessive total dietary fat, in the case of severe VHTG, or chylomicronemia), warrant intervention.
- When used to treat HTG, 4g/d prescription n-3FA effectively lowers TG by approximately 20-30%, while it does not significantly increase LDL-cholesterol. In REDUCE-IT trial, the use of n-3FA at this dose resulted in a 25% reduction in major adverse cardiovascular events.
- All forms of n-3 FA products have relatively benign side-effect profiles and are generally safe. In clinical trials of prescription n-3 FA agents, tolerability issues are relatively minor.
- Prescription n-3FA at a dose of 4g/day is an effective and safe option for reducing TG as monotherapy or as an adjunct to other lipid-lowering agents.
- This advisory is intended to inform healthcare providers about newly approved prescription n-3 FA and elaborate on the effects of n-3 FA as an adjunctive lipid-lowering therapy, particularly in combination with statins.
Citation
Skulas-Ray AC, Wilson PWF, Harris WS, Brinton EA, Kris-Etherton PM, Richter CK, Jacobson TA, Engler MB, Miller M, Robinson JG, Blum CB, Rodriguez-Leyva D, de Ferranti SD, Welty FK, on behalf of the American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Lifestyle and Cardiometabolic Health, Council on Lifelong Congenital Heart Disease and Heart Health in the Young, Council on Cardiovascular and Stroke Nursing, and Council on Clinical Cardiology. Omega-3 fatty acids for the management of hypertriglyceridemia: a science advisory from the American Heart Association [published online ahead of print August 19, 2019]. Circulation. doi: 10.1161/CIR.0000000000000709.