A Fishy Topic: VITAL, REDUCE-IT, STRENGTH, and Beyond: Putting Omega-3 Fatty Acids into Practice in 2021

Purpose of Review To examine recently published data from clinical outcome and arteriographic studies that examined the addition of omega-3 fatty acids, eicosapentaenoic acid (EPA) + docosahexanoic acid (DHA), to standard of care therapy on cardiovascular disease (CVD) risk. Recent Findings Several trials that tested purified EPA (JELIS, REDUCE-IT, EVAPORATE) were associated with reduced CVD risk and regression of low attenuation coronary plaque volume, whereas studies that employed the combination EPA/DHA (VITAL, OMEMI, STRENGTH) failed to derive clinical benefit. Trials testing purified EPA consistently demonstrated reduction in atheromatous volume or CVD events beyond standard of care therapies, whereas the combination of EPA/DHA did not, despite producing similar reductions in triglycerides. Experimental and in vitro data suggest that compared to DHA, EPA exhibits antioxidant, anti-inflammatory, and membrane stabilizing properties that enhance vascular function and CVD risk. Consequently, purified EPA appears to be the treatment of choice for high-risk patients with hypertriglyceridemia.

Automated summary

Recent studies comparing the addition of omega-3 fatty acids, specifically EPA and DHA, to standard of care therapy for cardiovascular disease have shown that purified EPA may provide more significant benefits in reducing CVD risk than the combination of EPA and DHA. Experimental data suggests that EPA has antioxidant, anti-inflammatory, and membrane stabilizing properties that may enhance vascular function and decrease CVD risk compared to DHA.