Omega-3 Fatty Acids in Hypertriglyceridemia Treatment

Dietary Recommendations

The American College of Cardiology recommends that all individuals consume at least 2 or more servings of fish/seafood per week for a total of 8 or more ounces, preferably fatty fish such as salmon, rainbow trout, and tuna, which provides approximately 250 mg per day of EPA+DHA, to help reduce coronary heart disease death 1, 3
For patients with triglyceride levels of 200-499 mg/dL, fatty fish consumption should be emphasized, while those with levels 500-999 mg/dL may need to consider lean fish options if fat intake restriction is necessary, as recommended by the American College of Cardiology 3, 5
Patients should prioritize fish varieties that are higher in EPA and DHA but lower in methylmercury, such as salmon, anchovies, sardines, Pacific oysters, and trout, according to the American College of Cardiology 5, 6
Dietary intake alone is insufficient for therapeutic triglyceride lowering in patients with hypertriglyceridemia, as current estimates of seafood consumption in the United States are only about 6 servings per month, as noted by the American College of Cardiology 6, 4

The American College of Cardiology indicates that icosapent ethyl (IPE) is currently the only triglyceride risk-based nonstatin therapy approved by the FDA for reduction in ASCVD risk 2
IPE is indicated as an adjunct to maximally tolerated statin therapy to reduce the risk of MI, stroke, coronary revascularization, and unstable angina requiring hospitalization in adult patients with elevated triglyceride levels and established cardiovascular disease or diabetes mellitus with ≥2 additional risk factors for cardiovascular disease, as recommended by the American College of Cardiology 2, 7
Lower-dose mixtures of EPA and DHA have failed to show significant reduction in cardiovascular endpoints in multiple large randomized controlled trials with contemporary background therapy, according to the American College of Cardiology 8, 9

The American College of Cardiology notes that multiple randomized controlled trials of prescription omega-3 fatty acids at higher doses have demonstrated an increased risk of atrial fibrillation 7, 2
Clinicians should evaluate the potential net benefit of prescription omega-3 fatty acids in patients at high risk of atrial fibrillation, as recommended by the American College of Cardiology 2
Common adverse effects of prescription omega-3 fatty acids include eructation, dyspepsia, taste perversion, musculoskeletal pain, peripheral edema, constipation, and gout, according to the American College of Cardiology 7, 2