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Doctors newspaper online, 25.08.2019
High triglycerides
Monotherapy with omega-3 fatty acids may be sufficient for patients with simple hypertriglyceridemia, according to new recommendations from the American cardiologist society.
By Robert Bublak
Benefits for the Heart through Fish Oil Capsules? Which dose is needed?
© morganka / Fotolia
DALLAS. Experts from the American Heart Association (AHA) have issued a scientific recommendation to prescribe omega-3 fatty acids to patients with hypertriglyceridemia ( Circulation 2019, online Aug. 19 ).
In their recommendation for the treatment of hypertriglyceridemia with the fish oils eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the AHA experts distinguish between simple (200-499 mg / dl) and markedly elevated triglyceride levels (≥ 500 mg / dl).
For patients with simple hypertriglyceridemia, even monotherapy with omega-3 fatty acids may be sufficient. On the other hand, patients with pronounced hypertriglyceridemia may need additional medications, such as statins, to come below the 500 mg / dl threshold and reduce the risk of pancreatitis. In addition, LDL cholesterol may rise under the combination therapy with fish oils.
As a dosage of omega-3 fatty acids, AHA practitioners report 4 g / day, either as a combination of EPA and DHA or as a pure EPA preparation.
Changing Lifestyles First!
A condition for the treatment with omega-3-fatty acids is that before all possible causes for the increase of the triglyceride concentration were addressed and dietetic as well as measures for the change of the lifestyle (alcohol renouncement!) Were taken.
The current guidelines of the European as well as the German society for Kardiologie consider it worth considering to use omega-3 fatty acids, if the therapy with statins and fibrates does not work sufficiently. That certainly does not sound so convincing, the data is considered inconclusive.
However, these guidelines are from 2016. The results of the REDUCE-IT study which were first presented last year, have not yet been evaluated.
Dosage in view
In REDUCE-IT, pure and high-dose eicosapentaenoic acid has been shown to significantly reduce the cardiovascular risk of patients with elevated triglyceride levels by 25 percent. It is also the results of REDUCE-IT that underpin the new AHA recommendations.
It is also important to keep an eye on the dosage. In the REDUCE-IT study, the subjects in the verum group had received a total of 4 g of eicosapentaenoic acid in pure form (icosapent-ethyl). In many negative studies, however, the doses of omega-3 fatty acids did not exceed 1 g / day.
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