OTC Omega-3 FA
-Take 4g/day PO divided qd-bid
Prescription Omega-3 FA
Prescription fish oil capsules contain a higher dose of omega-3 fatty acids than non-prescription versions.
Recommend prescription-strength fish oil if your triglycerides are very high (more than 500 mg/dL).
Lovaza (omega-3-acid ethyl esters) contain a combination of EPA and DHA. Take 4g/day PO divided qd-bid
Epanova (omega-3-carboxylic acids) contain a combination of EPA and DHA.
Vascepa (icosapent ethyl) contain EPA only. Take 2g PO bid.
For the prescription Omega-3 FA, also,
“Treatment of hypertriglyceridemia depends on its severity. Contributing factors include a sedentary lifestyle, being overweight, excessive alcohol intake, type 2 diabetes mellitus, and genetic disorders. Triglyceride levels of 150–199 mg/dL are considered mild hypertriglyceridemia, levels of 200–999 mg/dL are moderate, 1000–1999 mg/dL are severe, and levels >2000 mg/dL are considered very severe. Patients
with hypertriglyceridemia in the mild to moderate range may be at risk for cardiovascular disease, but those who have severe or very severe hypertriglyceridemia have a significant risk of pancreatitis. In addition to having the patient exercise, reduce intake of fat and carbohydrates, and lose weight, she
should also be counseled to avoid alcohol. For patients at risk for pancreatitis, fibrates are recommended as the initial treatment for pancreatitis. It should be noted that statins may have a modest
triglyceride-lowering effect and may be helpful in decreasing cardiovascular risk in those who have moderately elevated triglycerides. However, they should not be used alone in patients who have severe hypertriglyceridemia. Studies have also shown that while omega-3 fatty acids decrease triglycerides and very low-density lipoprotein cholesterol levels, they may increase LDL-cholesterol levels.
Treatment with omega-3 fatty acids does not decrease total mortality or cardiovascular events, and therefore is not recommended.Niacin does seem to have the advantage of raising HDL cholesterol and lowering LDL cholesterol, but it has never been proven in clinical trials to have benefit with regard to the primary outcome of cardiovascular disease, and some trials have shown significant increases in adverse events.
Ref: Stone NJ, Robinson JG, Lichtenstein AH, et al; American College of Cardiology/American Heart Association Task Force
on Practice Guidelines: 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic
cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on
Practice Guidelines. J Am Coll Cardiol 2014;63(25 Pt B):2889-2934. 2) Armstrong C: Endocrine Society releases
guidelines on diagnosis and management of hypertriglyceridemia. Am Fam Physician 2013;88(2):142-144. 2) Ebell MH:
Niacin does not improve clinical outcomes in patients with vascular disease. Am Fam Physician 2014;90(9):660-661. 3)
Narla R, Peck SB, Qiu KM: Fish oil for treatment of dyslipidemia. Am Fam Physician 2014;89(4):288, 290.”
“At a dosage of approximately 3 g/day, omega-3 (or n-3) fatty acids have been reported to reduce serum triglyceride concentrations by 25%–30%, with accompanying increases in LDL-cholesterol of 5%–10%, and in HDL-cholesterol of 1%–3%.”
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Good evidence shows that supplementation with omega-3 fatty acids decreases triglycerides.
“Level A evidence shows that supplementation with fish oil (omega-3 fatty acids) decreases triglycerides and very low–density lipoprotein (VLDL cholesterol) but can increase LDL-cholesterol. Treatment with fish oil has not been shown to decrease cardiovascular events, total mortality, or cancer incidence.” ABFM
References
Cochrane Database Syst Rev 2004;(4):CD003177.
Cochrane Database Syst Rev 2008;(1):CD003205.
Am Fam Physician 2014;89(4):288, 290.
http://www.aafp.org/afp/2013/0715/p142.html