For people with very high triglycerides, doctors generally recommend exercise and dietary changes, and if that doesn't work, statins, fibrates or niacin. But a new advisory from the American Heart Association says that prescription omega-3 fatty acids can help reduce very high trigylceride levels by 20 to 30%, and the medications can be used safely in conjunction with statins.
The association reached this conclusion by reviewing 17 randomized controlled trials involving patients with high triglyceride levels. People who were treated with 4 grams of prescription omega-3 fatty acids daily, regardless of the brand, saw positive results, and the drugs were effective in reducing triglyceride levels regardless of whether people were on a statin to lower cholesterol.
The US Food and Drug Administration has only approved these prescription medications for people who have very high triglyceride levels, above 500 mg/dL. There are two prescription versions of these medications on the market, and the association didn't recommend one form over the other.
"This is significant news and will likely change the way doctors practice," Dr. Michael Miller, co-author of the AHA advisory, a professor of medicine and director of the Center for Preventive Cardiology at the University of Maryland School of Medicine, said in an emailed statement.
The advisory warns people who have high triglyceride levels not to treat their condition with fish oil supplements they might purchase at the grocery store. Such supplements are not regulated by the FDA and shouldn't be used in place of medication.
What are triglycerides?
Triglycerides are fats that circulate in your blood. When you eat, your body converts the extra calories you've consumed into these fats. If you eat more calories than you burn, it can elevate your triglyceride levels and that may contribute to a hardening or narrowing of your arteries. That condition, called arteriosclerosis, can put people at an increased risk of having a heart attack or a stroke. People with extremely high triglycerides can also have problems with their pancreas.
If your doctor sees that you have a high level of triglycerides, it could also be a sign of Type 2 diabetes or prediabetes, a sign that your thyroid hormones are low, or an indication of a rare genetic condition. You may also have a high triglyceride level if you are taking certain medicines such as beta blockers or diuretics.
There are an increasing number of patients diagnosed with elevated triglyceride levels, and it's rising with the growing obesity rate.
'Pendulum swinging back on fish oil'
The advisory suggested doctors talk to their patients about lifestyle choices first and encourage them to improve diets, eat less sugar, get more exercise, lose weight and reduce the amount of alcohol they are drinking. Doctors might also tell patients to eat more fatty fish such as salmon a couple times a week.
If that doesn't lower patients' triglycerides enough, then doctors may want to prescribe omega-3 fatty acids. Patients with these prescriptions are instructed to take these pills with food, to reduce the potential side effects of an upset stomach.
"Triglycerides, there's almost nothing that can change for the good as rapidly as with a change in diet and exercise, but there are many, many people who need something else," said Dr. Karol Watson, a professor of medicine in the division of cardiology at the David Geffen School of Medicine at UCLA who was not affiliated with the advisory. "This is an important report and shows the pendulum swinging back on fish oil in this very specific form for these very specific patients."
In earlier studies, the evidence for omega-3s in heart patients with conditions other than high triglycerides has been mixed. Watson says it's unclear if there will come a time when doctors recommend omega-3s for patients with other types of heart problems, and much more research will be needed.