Now, an article published in August 2019 in the AHA journal Circulation further validates the benefits of these acids, finding that prescription fish oil medication lowers triglyceride levels by 20 to 30 percent in patients who already require triglyceride-reducing drugs. Triglycerides are the most common type of fat found in the blood, according to the American Heart Association (AHA). When levels are too high (above 200 milligrams per deciliter, or mg/dL), fatty deposits are more likely to build up in the arteries, which raises the risk of heart problems. The Cleveland Clinic notes that very high levels (above 500 mg/dL) of triglycerides can lead to pancreatitis, an inflammation of the pancreas. “About 25 to 30 percent of the adult population have high triglycerides [HTG] — that’s a lot,” says lead author Ann Skulas-Ray, PhD, assistant professor in the department of nutritional sciences at the University of Arizona in Tucson. “Prescription omega-3 fatty acid, in a dose of 4 grams daily, effectively reduces these triglycerides. In a large clinical trial of people with HTG, this dose also resulted in a 25 percent reduction in major adverse cardiovascular events, such as heart attacks and strokes.” Good sources of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) omega-3 fatty acids in food include fish such as tuna, mackerel, sardines, salmon, and shellfish, according to the AHA. Flaxseed, walnuts, and certain oils, including canola and soybean oil, are also good sources of omega-3s, but of the plant-based type, ALA (α-linolenic acid). The two major omega-3 fatty acids used in prescription medication are EPA and DHA. Some research has shown that plant-based omega-3s may be heart healthy but may not specifically lower triglycerides. Dr. Skulas-Ray and her team based their new findings on evidence from 17 randomized, controlled clinical trials on high triglyceride levels and prescription fish oil. The studies represented more than 10,000 people. Their conclusion that 4 g of prescription fish oil was the most effective dose contrasted with prior guidance from the AHA (published in 2002) recommending that 2 to 4 g of prescription agents was optimal for reducing triglycerides in patients with elevated levels. Currently, the FDA has approved prescription omega-3 fatty acid medication only for treating very high triglyceride levels above 500 mg/dL, according to the AHA. RELATED: How to Make Over Your Diet So It’s Heart Healthy
Omega-3 Supplements Were Helpful Even in People Taking Statins
People with elevated triglycerides are also likely to be on statin therapy as first-line treatment, says Skulas-Ray. Prior research has demonstrated that these common cholesterol-lowering drugs can also lower triglycerides. “A lot of people prescribed statin therapy will get a modest reduction in triglycerides, but those levels can still be high even though they are on the appropriate dose of statins,” says Skulas-Ray. In this analysis, authors concluded that omega-3 fatty acids were equally effective regardless of whether individuals were taking statins. They also noted that prescription fatty acids were safe and well tolerated, even when taken in combination with statins. The analysis indicated that fish oil prescriptions appeared to be safe and well-tolerated in children and adolescents as well. “This research really bolsters the argument that treating high triglycerides in and of itself will have beneficial cardiovascular effects,” says Joshua Knowles, MD, a cardiologist at Stanford Health Care in Palo Alto, California, who was not involved in the study. RELATED: 9 Things Dietitians Wish You Knew About High Cholesterol
How to Choose a Quality Omega-3 Medication
Of the two fish oil drugs approved by the FDA, Lovaza contains both EPA and DHA, while Vascepa contains only EPA. Past research, including a study published in August 2018 in the Journal of Clinical Endocrinology & Metabolism, has shown that DHA in particular may raise LDL (“bad”) cholesterol. The results of this study, however, found that the formula containing both EPA and DHA did not push up the “bad” form of cholesterol among most people with high triglyceride levels of 200 to 499 mg/dL. This only changed when the fish oil drug was given to people with very high triglyceride levels of 500 mg/dL or greater. Some of these patients experienced a higher percentage reduction of triglyceride levels but their LDL cholesterol rose, according to study authors. “This was one of the surprising findings of our analysis,” says Skulas-Ray. “The results we reviewed suggest to me that LDL increases proportionally to the degree of triglyceride reduction, not as a result of the prescription agent containing DHA.” The advisory group writes that it does not recommend one prescription drug over another. RELATED: 5 Diabetes-Friendly Foods That Offer Omega-3 Fatty Acids
Why Not Just Take Dietary Supplements and Eat Fish?
Skulas-Ray says that dietary supplements containing omega-3 fatty acids are not regulated by the FDA and should not be used in place of prescription medication for the long-term management of high triglycerides. “Getting prescription medications guarantees quality in a way that cannot be guaranteed with over-the-counter products,” says Dr. Knowles. This isn’t to say that nutritional supplements don’t have their place. “I think there is a role for dietary supplements in health maintenance in correcting deficient dietary intakes, but that is a completely separate question from clinical use where a physician is prescribing to a patient,” Skulas-Ray says. In an article published in April 2017 in the journal Circulation, the AHA said fish oil supplements may benefit individuals with diabetes and prediabetes, or those at high risk of heart disease, stroke, heart failure, and atrial fibrillation. While the AHA recommends that everyone eat at least two servings of fish per week, this eating habit is unlikely to cut triglycerides significantly in those people with high levels. “Food doses aren’t going to achieve the prescription dose unless possibly someone is eating a large helping of oily salmon every day,” Skulas-Ray says. “It’s just not a sustainable long-term solution.” RELATED: The Best Fish to Eat to Boost Your Heart Health
Why Making Lifestyle Changes Are Essential for Heart Health
Including sources of omega-3 fatty acids during meals is part of following a heart-healthy diet. Other lifestyle practices can also help maintain good triglyceride levels. “Diet, exercise, and modest weight loss are absolutely effective in decreasing triglycerides,” says Knowles. “For those with diabetes, control of blood glucose levels is also effective.” Losing weight, avoiding sugar and refined carbohydrates, limiting alcohol, and choosing healthier fats from plants in place of saturated fats may also keep triglycerides in check, the advisory investigators write. As far as limitations are concerned, authors based their advisory on a review of previous investigations; therefore, this paper is not an original clinical study based on first-hand observation of patients. Knowles believes future research is needed to figure out the mechanism by which lowering triglycerides prevents heart disease. “My overall recommendation is that if people suspect they may have high triglycerides, they should schedule an appointment with their physician,” says Skulas-Ray. “The physician can get a lipid profile [a screening for irregularities in cholesterol and triglycerides] and make prescribing decisions from there.” RELATED: 9 Simple Ways to Help Lower Your Cholesterol
