Heart Experts Support Use of Prescription Fish Oil to Lower Triglyceride Levels

Heart experts are advising that prescription-strength fish oil pills might help lower excess levels of blood fats known as triglycerides.

The pills contain heart-healthy omega-3 fatty acids. When prescribed by a doctor, these meds can lower high triglyceride levels by 20%-30%, according to a new American Heart Association science advisory.

"From our review of the evidence from 17 randomized, controlled clinical trials on high triglyceride levels, we concluded that treatment with 4 grams daily of any of the available prescription [omega-3 medications] is effective and can be used safely in conjunction with statin medicines that lower cholesterol," Ann Skulas-Ray said in an AHA news release. She is one of the authors of the advisory published in the journal Circulation.

Triglycerides are fats that circulate in the blood. Elevated levels of triglycerides (above 200 mg/dL) can lead to narrowing of the arteries, which increases the risk of heart attack and stroke.

About 25% of U.S. adults have triglyceride levels above 150 mg/dL, which is borderline high. Rates of elevated triglycerides are on the rise in the United States due to growing rates of obesity and diabetes, both of which boost triglyceride levels.

Very high levels of triglycerides (above 500 mg/dL) can also cause inflammation of the pancreas.

While the AHA comes out in favor of prescription fish oil supplements, it does not do the same for over-the-counter supplements.

"Dietary supplements containing omega-3 fatty acids are not regulated by the FDA," said Skulas-Ray, who is assistant professor of nutritional sciences at the University of Arizona in Tucson. "They should not be used in place of prescription medication for the long-term management of high triglycerides."

Furthermore, a 2017 AHA science advisory said there was a lack of scientific research to support clinical use of non-prescription omega-3 fatty acid supplements to prevent heart disease in the general population.

But according to the new guideline, prescription versions might help, at least when it comes to triglyceride levels. There are currently two prescription omega-3 fatty acid medications. One combines two types of fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), while the other has EPA only.

There have been no direct comparisons of the two different medications, so the advisory doesn't recommend one over the other.

Currently, U.S. Food and Drug Administration approval for prescription omega-3 fatty acid medications is limited to treatment of very high triglyceride levels (above 500 mg/dL).

Two experts in heart health agreed that prescription fish oil pills might have a role to play in cardiovascular care.

"This is an exciting time with more trials underway in this medication class, which has already been shown to have very few side effects, very few interactions with other medications and evidence for tremendous cardiovascular benefits," said Dr. Eugenia Gianos. She is director of Women's Heart Health at Lenox Hill Hospital in New York City.

Dr. Benjamin Hirsh directs preventive cardiology at Northwell Health's Sandra Atlas Bass Heart Hospital in Manhasset, N.Y. Reading over the new advisory, he said that "triglycerides are now becoming the new 'bad cholesterol.'

"The importance of managing triglycerides cannot be underestimated," Hirsh said. Up until now there's been little expert guidance to help doctors treat excess levels of these blood fats.

Luckily, unlike the case of LDL "bad" cholesterol, "triglycerides are much more sensitive to lifestyle changes, with reductions in carbohydrates, weight, alcohol and increases in physical activity associated with reductions [of triglyceride levels] by almost 50%," Hirsh noted.

In the meantime, he said, "more trials are expected to result in 2020 that will help direct specific guidance for the use of different fish oil medications to reduce triglycerides and cardiovascular risk."

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