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Controversies in the Use of Omega-3 Fatty Acids to Prevent Atherosclerosis

  • Cardiometabolic Disease and Treatment (R. Santos, Section Editor)
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A Correction to this article was published on 28 May 2022

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Abstract

Purpose of Review

We discuss current controversies in the clinical use of omega-3 fatty acids (FA), primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and examine discrepancies between recent trials. Furthermore, we discuss potential side effects reported in these studies and the role of mixed omega-3 FA dietary supplements and concerns about their use.

Recent Findings

REDUCE-IT showed that addition of icosapent ethyl, a highly purified form of EPA, can reduce risk of cardiovascular events among statin-treated individuals with high triglycerides. Additional supportive evidence for EPA has come from other trials and meta-analyses of omega-3 FA therapy. In contrast, trials of mixed EPA/DHA products have consistently failed to improve cardiovascular outcomes. Discrepancies in results reported in RCTs could be explained by differences in omega-3 FA products, dosing, study populations, and study designs including the placebo control formulation. Evidence obtained from highly purified forms should not be extrapolated to other mixed formulations, including “over-the-counter” omega-3 supplements.

Summary

Targeting TG-rich lipoproteins represents a new frontier for mitigating ASCVD risk. Clinical and basic research evidence suggests that the use of omega-3 FA, specifically EPA, appears to slow atherosclerosis by reducing triglyceride-rich lipoproteins and/or inflammation, therefore addressing residual risk of clinical ASCVD.

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References

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  1. Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA

    Renato Quispe, Abdulhamied Alfaddagh, Brigitte Kazzi, Fawzi Zghyer, Francoise A. Marvel, Roger S. Blumenthal, Garima Sharma & Seth S. Martin

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  1. Renato Quispe
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  2. Abdulhamied Alfaddagh
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Under a license agreement between Corrie Health and the Johns Hopkins University, the University owns equity in Corrie Health and the University, Dr. Marvel and Dr. Martin are entitled to royalty distributions. Additionally, Dr. Marvel and Dr. Martin are co-founders of and hold equity in Corrie Health. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. Dr. Marvel has received research support from Apple and iHealth.

Dr. Martin also reports personal fees from Amgen, AstraZeneca, Esperion, 89bio, Sanofi-Aventis, Novo Nordisk, iHealth, Novartis, and DalCor; non-financial support from Apple and iHealth; grants and non-financial support from Google; and grants from Maryland Innovation Initiative, American Heart Association, Aetna Foundation, PJ Schafer Memorial Fund, David and June Trone Family Foundation, National Institutes of Health, and FH Foundation, outside the submitted work.

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Quispe, R., Alfaddagh, A., Kazzi, B. et al. Controversies in the Use of Omega-3 Fatty Acids to Prevent Atherosclerosis. Curr Atheroscler Rep 24, 571–581 (2022). https://doi.org/10.1007/s11883-022-01031-9

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