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Hypertriglyceridemia and Omega-3 Fatty Acids
Study Questions:
What is the pathogenic role of triglycerides (TGs) in cardiometabolic risk, and what is the potential role of omega-3 fatty acids (O3FAs) in the management of hypertriglyceridemia and cardiovascular disease?
Methods:
The investigators identified relevant studies of O3FAs by conducting a PubMed search of randomized controlled trials published since January 1, 1997, with “omega-3,” “n-3,” “eicosapentaenoic acid,” “docosahexaenoic acid,” or “icosapent ethyl” in the title or abstract. Primary and secondary intervention studies that examined cardiovascular endpoints, lasted for at least 1 year, and included a control arm were considered for analysis.
Results:
O3FAs reliably reduce TGs by 20%–50%, and affect both fasting and nonfasting levels. For this reason, O3FA supplements are one of the pharmacological therapies recommended for patients with elevated TGs. However, with the exception of the JELIS study in Japanese patients, there are limited data on the impact of adding O3FAs to statin therapy in patients who require TG lowering in addition to low-density lipoprotein cholesterol (LDL-C) lowering.
Conclusions:
The authors concluded that targeting resistant hypertriglyceridemia should be considered as a part of clinical management of cardiovascular risk and O3FAs may represent a valuable resource to this aim.
Perspective:
This study reports that O3FAs lower TG levels and may have other beneficial physiological effects on lipid transport and atherosclerosis development. Meta-analyses of clinical trials with these agents indicate a significant reduction in the risk of recurrent myocardial infarction when used as secondary prevention. It should be noted that for patients with moderately elevated TG levels, LDL-C remains the primary target for treatment in both US and European guidelines. Dietary changes should be a key element of first-line lifestyle intervention, but pharmacological treatment including O3FAs may be indicated in people with persistently high TG levels. Two trials, the REDUCE-IT study (NCT01492361) and the STRENGTH study (NCT02104817), are investigating the impact of adding O3FAs to statin therapy and will define their role further. For now, statins remain the cornerstone of pharmacological therapy in those with dyslipidemia.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Diet
Keywords: Atherosclerosis, Cholesterol, LDL, Dietary Supplements, Docosahexaenoic Acids, Dyslipidemias, Eicosapentaenoic Acid, Fasting, Fatty Acids, Omega-3, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertriglyceridemia, Life Style, Metabolic Syndrome, Myocardial Infarction, Primary Prevention, Risk Factors, Secondary Prevention, Triglycerides
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