Omega-3s + Heart Health
Over the last 3-weeks there has been a lot of media attention placed on omega-3s for heart health and cardiovascular disease risk management.
This follows in the wake of findings from the STRENGTH trial, a large-scale clinical trial of the omega-3 drug Epanova published in the journal JAMA. The trial, funded by AstraZeneca, was stopped early because it showed no effect of Epanova for reducing the risk of death in individuals with high triglycerides.
The reason there is so much media attention is that the 2019 REDUCE-IT clinical trial of the omega-3 drug Vascepa (Amarin Pharma) showed a 25% lower risk of death in individuals with high triglycerides.
Two major clinical trials of similar drugs show very different outcomes.
This can create confusion for prescribing healthcare providers and the patients that might consider these therapies. It also leaves the general population confused because the of the general link between omega-3s and health.
What we are seeing happen in the omega-3 industry is a modification of these fats by pharmaceutical companies to allow for potential patenting as a drug. Amarin Pharma did this with Vasceepa (an EPA derivative) and the STRENGTH study used a carboxylic acid form of EPA+DHA.
The benefit of these studies, is that they used high doses of their respective omega-3s, compared to earlier studies of omega-3 drugs (e.g. VITAL-D, ORIGIN and others) that were conducted prior to 2014 and only used 1g/d.
In my opinion, a dose of ~1g/d of omega-3s is something to be used preventatively and for the maintenance of good health – not for therapeutic effect for a health condition
Some of my colleagues argue that DHA might have negative effects on cardiovascular disease because it can play a slightly different biological role compared to EPA. Others point to higher saturated fat contents in some omega-3 supplements (Vascepa had almost none). While others consider the overall structure of these modified omega-3s.
While the results of the STRENGTH trial were not positive, they were also not negative – just no effect for modifying the risk of death from cardiovascular disease risk in a specific population group.
It is also important to keep in mind that the patients in both trials were already taking statin medications (drugs to lower triglycerides and decrease cardiovascular disease risk) and the trial was not design for primary risk reduction, but for more complex patients already on multiple medications.
While the study was with an omega-3, both were very specialized version that differs from what I use in my research.
The challenge I face from these negative findings (which are important for the scientific process) is that people will generalize the results to all omega-3s, forgetting that this was a drug trial for a specific condition, in a specific group of patients.
It is interesting that the media does not seem as ‘excitable’ when pharmaceutical compounds, or biological trials fail - but when it is something more tangible, like omega-3s, then the media gets all worked up.
My take away...
1) The omega-3 drug Vascepa can be effective for reducing risk of death from cardiovascular disease in individuals who are at high risk with high triglycerides and taking statins.
2) The omega-3 drug Epanova is not effective for reducing risk of death in the same population.
3) Population intake of omega-3s is very low and these fats are essential for many processes throughout the body, especially nerve health.
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