Do omega-3 fatty acid supplements reduce CV risk?

 Mounting evidence suggests they don’t...despite prior evidence with Rx Vascepa (icosapent ethyl), a form of EPA (eicosapentaenoic acid).

Vascepa 2 g BID is approved to reduce CV risk in some high-risk patients with elevated triglycerides despite statins.

Now evidence suggests that adding Rx Epanova 4 g/day for about
 3 years does NOT improve CV outcomes in high-risk patients on statins.

Epanova is a combo of EPA and DHA (docosahexaenoic acid) for severely high triglycerides over 5.6 mmol/L.  But it’s not approved in Canada...since the company was awaiting results of this CV trial.

Other new data show no CV benefit of a European omega-3 product with 1.8 g/day EPA and DHA after about 2 years in seniors with a recent heart attack.

Plus older studies with omega-3 doses of about 1 g/day are conflicting or suggest only slight benefit in some CV patients.

The contrasting data have researchers scratching their heads.

Some question if DHA negates the CV benefit of EPA.  Or if Vascepa’s results were inflated by the study’s mineral oil placebo, which may have increased CV risk...possibly by reducing statin absorption.

For example, mineral oil raised LDL and high-sensitivity C-reactive protein.   This wasn’t seen with the Epanova study’s corn oil placebo.

Educate that the CV benefits of omega-3s seem questionable... and all omega-3s may NOT have the same effects.  Keep in mind, fish oil supplements have both EPA and DHA.

Consider risks.  Rx omega-3s are linked with increased risk of atrial fib...and omega-3 doses above 3 g/day may increase bleeding.

Plus Vascepa costs about $320/month.

Advise saving Vascepa for patients with severely high triglycerides...to possibly reduce the risk of pancreatitis.

Don’t rely on omega-3s for CV benefits.  If needed, reinforce other measures...an optimized statin, BP control, smoking cessation, etc.

If a patient wants to use a fish oil supplement, encourage them to get one with a Health Canada Natural Product Number (NPN).

But point out that CV benefit isn’t likely, no matter the dose or source (krill oil, etc).

Explore our chart, Omega-3s: Fish Oil and More, for guidance about dietary intake...and a deeper dive into the evidence.

View additional resources.

Key References

• JAMA 2020;324(22):2268-80
• Circulation Published online Nov 15, 2020; doi:10.1161/CIRCULATIONAHA.120.052209
• N Engl J Med 2019;380(1):11-22

Pharmacist’s Letter Canada. January 2021, No. 370105