Journal article
Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association
Circulation (New York, N.Y.), Vol.140(12), pp.E673-E691
09/17/2019
DOI: 10.1161/CIR.0000000000000709
PMID: 31422671
Abstract
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 becoming increasingly prevalent in the United States and elsewhere, likely driven in large part by growing rates of obesity and diabetes mellitus. In a 2002 American Heart Association scientific statement, the omega-3 fatty acids (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. 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; these agents are also widely used for hypertriglyceridemia. The purpose of this advisory is to summarize 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. 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, whereas EPA-only did not raise low-density lipoprotein cholesterol in very high triglycerides. 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 low-density lipoprotein cholesterol when used as monotherapy or in combination with a statin. In the largest trials of 4 g/d prescription n-3 FA, non-high-density lipoprotein cholesterol 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. The results of a trial of 4 g/d prescription EPA+DHA in hypertriglyceridemia are anticipated in 2020. We conclude 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.
Details
- Title: Subtitle
- Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association
- Creators
- Ann C. Skulas-Ray - University of ArizonaPeter W. F. Wilson - Emory UniversityWilliam S. HarrisEliot A. Brinton - Utah Lipid Ctr, Salt Lake City, UT USAPenny M. Kris-Etherton - Pennsylvania State UniversityChesney K. Richter - University of ArizonaTerry A. Jacobson - Emory UniversityMary B. Engler - Uniformed Serv Univ Hlth Sci, Grad Sch Nursing, Bethesda, MD 20814 USAMichael Miller - Univ Maryland, College Pk, MD 20742 USAJennifer G. Robinson - University of IowaConrad B. Blum - Columbia UniversityDelfin Rodriguez-Leyva - St Boniface Gen Hosp, Res Ctr, Inst Cardiovasc Sci, Winnipeg, MB, CanadaSarah D. de Ferranti - Childrens Hosp Boston, Boston, MA USAFrancine K. Welty - Beth Israel Deaconess Medical CenterAmerican Heart Association Council on Arteriosclerosis, Thrombosis and Vascular BiologyCouncil on Lifestyle and Cardiometabolic HealthCouncil on Cardiovascular and Stroke NursingCouncil on Clinical Cardiology
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.140(12), pp.E673-E691
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1161/CIR.0000000000000709
- PMID
- 31422671
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Number of pages
- 19
- Language
- English
- Date published
- 09/17/2019
- Academic Unit
- Epidemiology; Fraternal Order of Eagles Diabetes Research Center
- Record Identifier
- 9984364408502771
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