Purpose of Review
Populations with significant dietary fish intake tend to have lower cardiovascular (CV) risk and demonstrable physiologic differences including lower lipid/lipoprotein levels and other direct and indirect effects on the arterial wall and inhibiting factors that promote atherosclerosis. Treatment with high doses of pharmacologic-grade omega-3 fatty acid (n-3FA) supplements achieves significant reductions in triglycerides (TG), non-high-density lipoprotein- (non-HDL-) and TG-rich lipoprotein- (TRL-) cholesterol levels. n-3FA supplements have significant effects on markers of atherosclerosis risk including endothelial function, low-density lipoprotein (LDL) oxidation, cellular and humoral markers of inflammation, hemodynamic factors, and plaque stabilization. This review summarizes the lipid and cardiometabolic effects of prescription-grade n-3FAs and will discuss clinical trials, national/organizational guidelines, and expert opinion on the impact of supplemental n-3FAs on CV health and disease.
Clinical trial evidence supports use of n-3FAs in individuals with established atherosclerotic cardiovascular disease (ASCVD), but the data either does not support or is lacking for other types of cardiometabolic risk including prevention of stroke, treatment in patients with heart failure, diabetes mellitus and prediabetes, and for primary prevention in the general population.
Despite inconsistent findings to support widespread benefit, there is persistent population-wide enthusiasm for n-3FA as a dietary supplement for its cardiometabolic benefits. Fortunately, there are ongoing clinical trials to assess whether the lipid/lipoprotein benefits may be extended to other at-risk populations and whether lower-dose therapy may provide background benefit for primary prevention of ASCVD.
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Conflict of Interest
Megan F. Burke and Frances M. Burke declare no conflict of interest.
Dr. Soffer reports that he has participated as a local investigator in pharmaceutical company-sponsored clinical trials that provide program support. He has been an investigator with Akcea, Ionis, Novartis, Pfizer, Regeneron, Sanofi, Amgen, Omthera/Astra Zeneca, Regenex/NIH, and Kowa pharmaceuticals, outside the submitted work. He has also received faculty payment for services as a course director for the National Lipid Association.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Nonstatin Drugs
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Burke, M.F., Burke, F.M. & Soffer, D.E. Review of Cardiometabolic Effects of Prescription Omega-3 Fatty Acids. Curr Atheroscler Rep 19, 60 (2017). https://doi.org/10.1007/s11883-017-0700-z
- Dietary supplement
- Omega-3 FA (n-3FA)
- Eicosapentaenoic acid (EPA)
- Docosahexaenoic acid (DHA)
- Linoleic acid (LA)
- Alpha-linolenic acid (ALA)
- Triglycerides (TG)
- Ethyl ester (EE)
- Fatty acid (FA)
- Free FA (FFA)