The following are key points to remember from this American Heart Association (AHA) Science Advisory Statement on omega-3 fatty acids (n-3 FAs) for the management of hypertriglyceridemia:

1. Fasting plasma triglyceride concentrations may be categorized as normal (<150 mg/dl), borderline (150–199 mg/dl), high (200–499 mg/dl), and very high (≥500 mg/dl).
2. Hypertriglyceridemia (triglycerides 200–499 mg/dl) is relatively common in the United States, whereas more severe triglyceride elevations (very high triglycerides, ≥500 mg/dl) are far less frequently observed. Both are likely driven in large part by growing rates of obesity and diabetes mellitus.
3. In a 2002 AHA Scientific Statement, the n-3 FAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were recommended (at a dose of 2–4 g/d) for reducing triglycerides in patients with elevated triglycerides.
4. Since 2002, prescription agents containing EPA+DHA or EPA alone have been approved by the US Food and Drug Administration for treating very high triglycerides and these agents are widely used for hypertriglyceridemia.
5. This advisory summarizes the lipid and lipoprotein effects resulting from pharmacological doses of n-3 FAs (>3 g/d total EPA+DHA) on the basis of new scientific data and availability of n-3 FA agents.
6. In treatment of very high triglycerides with 4 g/d, EPA+DHA agents reduce triglycerides by ≥30% with concurrent increases in low-density lipoprotein cholesterol (LDL-C), whereas EPA-only did not raise LDL-C in very high triglycerides.
7. When used to treat hypertriglyceridemia, n-3 FAs with EPA+DHA or with EPA-only appear roughly comparable for triglyceride lowering and do not increase LDL-C when used as monotherapy or in combination with a statin.
8. In the largest trials of 4 g/d prescription n-3 FA, non–HDL-C and apolipoprotein B were modestly decreased, indicating reductions in total atherogenic lipoproteins. The use of n-3 FA (4 g/d) for improving atherosclerotic cardiovascular disease risk in patients with hypertriglyceridemia is supported by a 25% reduction in major adverse cardiovascular events in REDUCE-IT (Reduction of Cardiovascular Events With EPA Intervention Trial), a randomized placebo-controlled trial of EPA-only in high-risk patients treated with a statin.
9. Results from the STRENGTH (Study to Assess STatin Residual Risk Reduction With EpaNova in HiGh CV Risk PatienTs With Hypertriglyceridemia) trial; ClinicalTrials.gov Identifier: NCT02104817, a randomized placebo-controlled cardiovascular outcomes trial of 4 g/d prescription EPA+DHA in patients with high triglycerides and low HDL-C on statins, are anticipated in 2020.
10. Based on available evidence, the advisory committee concluded that prescription n-3 FAs (EPA+DHA or EPA-only) at a dose of 4 g/d (>3 g/d total EPA+DHA) are an effective and safe option for reducing triglycerides as monotherapy or as an adjunct to other lipid-lowering agents after any underlying causes are addressed and diet and lifestyle strategies are implemented.

Keywords: Apolipoproteins B, Cholesterol, LDL, Diabetes Mellitus, Type 2, Diet, Docosahexaenoic Acids, Dyslipidemias, Eicosapentaenoic Acid, Fasting, Fatty Acids, Omega-3, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertriglyceridemia, Hypolipidemic Agents, Life Style, Metabolic Syndrome, Obesity, Primary Prevention, Risk Reduction Behavior, Triglycerides

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