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My sufferers generally ask me whether or not they need to strive one complement or one other. Typically my reply is equivocal, as a result of for many dietary supplements we simply don’t have sufficient proof to offer a particular reply. This doesn’t imply specific affected person couldn’t profit from a particular complement; it simply means I don’t have standardized analysis to information my suggestions. Sadly, this stays true of omega-Three fatty acid dietary supplements. The outcomes of research omega-Three dietary supplements have been inconsistent, and have left each physicians and sufferers questioning what to do.

Omega-Three fatty acids present profit in REDUCE-IT trial and win FDA approval

Two primary omega-Three fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are discovered primarily in fish and fish oil. Omega-3s from fish and fish oil have been really useful by the American Coronary heart Affiliation (AHA) for the previous 20 years to scale back cardiovascular occasions, like coronary heart assault or stroke, in individuals who have already got heart problems (CVD). I’ve written about and been a robust advocate of getting omega-3s by means of eating regimen, and typically by means of the usage of dietary supplements.

Over the previous yr I’ve prescribed an omega-Three, bought beneath the model identify Vascepa, to my sufferers who’re at excessive danger for CVD, based mostly on proof of cardiovascular advantages. Vascepa incorporates purified EPA, and its use is predicated on good medical information from the REDUCE-IT trial. This examine enrolled over eight,000 sufferers with elevated cardiovascular danger and excessive blood triglyceride ranges. They assigned half of the examine contributors to obtain 2 grams of Vascepa twice a day, and assigned the opposite contributors a placebo (a capsule crammed with mineral oil). The outcomes confirmed a major advantage of Vascepa over the placebo. Vascepa lowered blood triglyceride ranges, however extra importantly, it lowered the variety of coronary heart assaults and strokes, the necessity for a coronary heart stenting process to open clogged arteries, and dying.

A subsequent meta-analysis, which included information from over 10 research, discovered fish oil omega‐Three dietary supplements lowered danger for coronary heart assault and dying from coronary coronary heart illness.

In December 2020, the FDA permitted the usage of Vascepa to scale back the chance of cardiovascular occasions in sure sufferers with, or at excessive danger for, CVD.

STRENGTH trial casts some doubt on omega-Three advantages

However a latest examine has raised some questions. The STRENGTH trial, printed in JAMA, checked out a special formulation of omega-Three fish oil — a mix of EPA and DHA — to see if it might additionally cut back cardiovascular danger. This examine enrolled over 13,000 sufferers who have been randomized to obtain both the EPA/DHA mixture capsule or the placebo (a capsule crammed with corn oil). The trial was terminated early because of an interim evaluation revealing no distinction between the 2 remedy teams.

We don’t know for sure why the REDUCE-IT trial confirmed a profit from omega-3s whereas the STRENGTH trial didn’t. One chance is that the totally different outcomes are because of the totally different medication studied. REDUCE-IT studied a purified formulation of high-dose EPA, which resulted in greater EPA ranges. This was just like the outcomes of one other trial, which additionally discovered that pure EPA lowered the chance of cardiac occasions. The STRENGTH trial examined a mix of EPA and DHA. No giant examine has ever evaluated the consequences on cardiovascular outcomes of purified DHA alone, leaving us to wonder if DHA may counteract the advantages of EPA.

The place will we stand?

Again to my sufferers who need to know if they need to be taking an omega-Three complement. With the supply of in the present day’s information, I might advocate a pure EPA complement, or one which incorporates extra EPA than DHA. However don’t cease there. Eat a heart-healthy eating regimen, get common train, and pursue different life-style modifications which have confirmed advantages for cardiovascular well being. Within the meantime, my colleagues and I anticipate extra definitive information on the utility of omega-Three fish oil, and who may profit probably the most.

The submit Omega-Three fatty acids and the center: New proof, extra questions appeared first on Harvard Well being Weblog.

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