N-3 fatty acids for hypertriglyceridemia in patients taking second-generation antipsychotics

Cardiovascular disease is a frequent cause of early disability and death in patients with severe mental illness (SMI). Second-generation antipsychotic medications may cause increased risk of cardiovascular disease in some patients by elevating serum triglyceride levels. Idiopathic hypertriglyceridemia can be effectively treated with N-3 fatty acid (N-3 FA) supplementation, but little research has evaluated this treatment for hypertriglyceridemia that can occur in patients using second-generation antipsychotics.

A six-week, open-label pilot study of N-3 FA, two grams twice daily, was performed to assess efficacy of this supplement in patients with SMI who were being treated with second-generation antipsychotics. Serum triglyceride levels (the main endpoint) were assessed at baseline and six weeks. Levels of C-reactive protein (CRP), cholesterol (total, high density lipoprotein [HDL] and low density lipoprotein [LDL]), fasting glucose, and fasting insulin (to calculate the Homeostatic Model Assessment for Insulin Resistance [HOMA-IR]), as well as weight and blood pressure, were also assessed.

Mean triglyceride levels decreased by 70.4±50.4 mg/dL (p=0.001). Among secondary endpoints, mean HDL increased by 2.6±3.5 (p=0.03). However, LDL and total cholesterol, blood pressure, HOMA-IR and CRP did not significantly change.

In this pilot study, treatment with N-3 FA was associated with improvements in triglyceride and HDL levels. Further study is warranted to assess more completely whether this prescription dietary supplement can reduce triglycerides in patients taking second-generation antipsychotics.