By Marilynn Larkin
NEW YORK (Reuters Health) - Eicosapentaenoic acid (EPA) was associated with improved cardiovascular outcomes and reduced mortality, in a systematic review and meta-analysis of trials of omega-3 fatty acids (FA).
"These findings will bring some clarity to the medical community that not all omega-3 fatty acid preparations are the same," Dr. Deepak Bhatt of Brigham and Women's Hospital Heart and Vascular Center in Boston told Reuters Health by email. "Specifically, the weight of evidence supports the cardiovascular benefits of EPA, not mixtures of docosahexaenoic acid (DHA) and EPA."
"Based on the results of REDUCE-IT (https://bit.ly/3BrLJ61), the FDA approved the use of icosapent ethyl (2 grams twice daily) in patients with elevated triglycerides and either established cardiovascular disease or diabetes plus additional cardiovascular risk factors," he said. "For people who don't fall into those categories, the best approach to reducing their cardiovascular risk - beyond the usual eat right and exercise - is to eat a diet that contains a high amount of omega-3 fatty acids."
"We are studying higher doses to see if this approach is safe and well-tolerated," he added. "If the answer is yes, that will hopefully serve as a prelude to clinical trials of using a higher initial dose of EPA in patients such as those presenting with heart attacks."
As reported in EClinical Medicine, the meta-analysis included 38 randomized controlled trials of omega-3 FA with close to 150,000 participants. Findings were stratified by EPA monotherapy and EPA+DHA therapy.
Overall, omega-3 FA was associated with a reduction in cardiovascular mortality (rate ratio, 0.93), non-fatal myocardial infarction (RR, 0.87), coronary heart disease events (RR, 0.91), major adverse cardiovascular events (MACE; RR, 0.95), and revascularization (RR, 0.91).
Higher RR reductions were achieved with EPA monotherapy (0.82) than with EPA + DHA (0.94) for cardiovascular mortality, non-fatal MI (EPA, 0.72; EPA+DHA, 0.92), coronary heart disease events (EPA, 0.73; EPA+DHA, 0.94, as well for MACE and revascularization.
However, omega-3 FA increased incident atrial fibrillation (AF; RR, 1.26). Specifically, EPA monotherapy vs. control was associated with a higher risk of total bleeding (RR, 1.49) and AF (RR, 1.35).
Dr. Renee Bullock-Palmer, Director of the Women's Heart Center and Non-Invasive Cardiac Imaging at Deborah Heart and Lung Center in Browns Mills, New Jersey, commented on the study in an email to Reuters Health.
"Improved cardiovascular health and reduced mortality are associated with the use of pure fish oil tablets with EPA, which has a better effect than over-the-counter fish oil tablets that typically have a combination of EPA-DHA," she said. "Cholesterol blood test levels should be done regularly and the dose of EPA should be titrated up to lower cholesterol levels to the appropriate clinical targets."
Further, she noted, "Patients who are on blood thinners should be careful about the use of pure fish oil EPA tablets, as EPA was associated with increased risk of bleeding."
SOURCE: https://bit.ly/3BuhV96 EClinical Medicine, online July 8, 2021