My sufferers generally ask me whether or not they need to strive one complement or one other. Usually 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 selected 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 predominant 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 advisable by the American Coronary heart Affiliation (AHA) for the previous 20 years to cut 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 robust advocate of getting omega-3s by means of food regimen, and typically by means of the usage of dietary supplements.

Over the previous yr I’ve prescribed an omega-3, bought beneath the model title Vascepa, to my sufferers who’re at excessive danger for CVD, based mostly on proof of cardiovascular advantages. Vascepa incorporates 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 danger 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 major 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 dying.

A subsequent meta-analysis, which included information from over 10 research, discovered fish oil omega‐3 dietary supplements lowered danger for coronary heart assault and dying from coronary coronary heart illness.

In December 2020, the FDA accredited the usage of Vascepa to cut back the danger of cardiovascular occasions in sure sufferers with, or at excessive danger for, CVD.

STRENGTH trial casts some doubt on omega-3 advantages

However a latest examine has raised some questions. The STRENGTH trial, printed in JAMA, checked out a unique formulation of omega-3 fish oil — a mix of EPA and DHA — to see if it might additionally scale back cardiovascular danger. This examine enrolled over 13,000 sufferers who have 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 result of an interim evaluation revealing no distinction between the 2 remedy 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 totally different outcomes are as a result of totally different medicine studied. REDUCE-IT studied a purified formulation of high-dose EPA, which resulted in greater EPA ranges. This was much like the outcomes of another trial, which additionally discovered that pure EPA lowered the danger 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 would possibly counteract the advantages of EPA.

The place can we stand?

Again to my sufferers who need to know if they need to be taking an omega-3 complement. With the provision of immediately’s information, I might suggest a pure EPA complement, or one which incorporates extra EPA than DHA. However don’t cease there. Eat a heart-healthy food 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 would possibly profit essentially the most.

The submit Omega-3 fatty acids and the heart: New evidence, more questions appeared first on Harvard Health Blog.