special subjects
Fish Oil
Evidence
Previously, evidence indicated that EPA/DHA (EPA plus DHA in various combinations) 800 to 1500 mg/day reduces risk of myocardial infarction and death due to arrhythmia in patients who have preexisting coronary artery disease and are taking conventional drugs ( References ). EPA/DHA also reduces triglycerides. The 2021 OMEMI trial (Omega-3 Fatty acids in Elderly with Myocardial Infarction) was a randomized clinical trial in which 1027 patients aged 70 to 82 years with recent (2 to 8 weeks) acute myocardial infarction were treated with 1.8 g of n-3 polyunsaturated fatty acids (PUFA) (930 mg eicosapentaenoic acid and 660 mg docosahexaenoic acid) or placebo (corn oil) daily in addition to standard of care. The primary endpoint was a composite of nonfatal acute myocardial infarction, unscheduled revascularization, stroke, all-cause death, and heart failure hospitalization after 2 years. The primary endpoint occurred in 21.4% patients on n-3 PUFA versus 20.0% on placebo (P=0.60). The authors concluded that the study did not detect a reduction in clinical events in older patients with recent acute myocardial infarction ( References ). A 2016 review verified strong evidence for a dose-dependent triglyceride-lowering effect. However there was moderate-strength quality evidence for decreased risk of cardiovascular death and major adverse cardiovascular events, and low-strength quality evidence that higher doses are associated with lower risk of coronary artery disease and heart failure. There was no blood pressure–lowering effect ( References ). The 2020 Cochrane review of 86 randomized controlled trials (162,796 subjects) of 12 to 88 months duration confirmed that omega-3 fatty acids decrease triglycerides and, per high-certainty evidence, have little effect on cardiovascular events and death. The review found slightly decreased cardiovascular mortality but no difference in the number of strokes or arrhythmias. The review noted that 167 participants needed treatment to prevent one coronary event, and 334 participants needed treatment to prevent one death due to coronary artery disease ( References ). However, the REDUCE-IT trial, which enrolled patients with established cardiovascular disease or with diabetes and other risk factors plus elevated triglyceride levels despite statin treatment, reported a significant reduction in MACE (major adverse cardiac events) using the prescription pharmacologic agent supplements and advises that only FDA-approved prescription products be used for hypertriglyceridemia ( References ). 