HelixTalk Episode #112 - Fishing for Benefits - The Evidence for ASCVD Risk Reduction for Fish Oils

Date posted: April 28, 2020, 6:00 am

In this episode, we will discuss the most recent evidence for the use of omega-3 fatty acids (fish oil) for ASCVD risk reduction.

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Key Concepts

1. Not all fish oil products are alike.  Over-the-counter formulations have variable amounts of EPA and DHA in them and are not regulated in the same way as prescription products are.  Generally only prescription products have been studied in more modern randomized controlled trials.
2. The use of fish oil supplements for primary ASCVD prevention is not recommended.  Instead, current guidelines recommend consumption of fatty fish twice a week.
3. For secondary ASCVD prevention, EPA-only fish oil (icosapent ethyl, brand name Vascepa) may offer cardiovascular protection (based on the REDUCE-IT trial); however, the medication comes with a large pill burden and may be cost prohibitive for some patients.
4. More modern trials have confirmed that the use of fish oil supplements increases the risk of new onset atrial fibrillation and hospitalization due to atrial fibrillation.

References

• Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med.2018; 380:11-22. https://www.nejm.org/doi/full/10.1056/NEJMoa1812792