Fish Oil and Cardiometabolic Diseases: Recent Updates and Controversies

Area of Science:

• Cardiovascular Medicine
• Nutritional Science
• Pharmacology

Background:

• Omega-3 (n-3) polyunsaturated fatty acids, primarily eicosapentaenoic acid and docosahexaenoic acid from fish oil, have a debated role in cardiovascular health.
• Previous large trials yielded conflicting results regarding the efficacy of omega-3 fatty acids in patients with established cardiovascular disease or major vascular events.
• Recent studies like JELIS, VITAL, STRENGTH, and ASCEND aimed to resolve data gaps on omega-3s for cardiovascular event prevention and their risk-benefit profile.

Purpose of the Study:

• To review recent evidence on the use of various fish oil forms (supplements and prescription) in cardiometabolic diseases.
• To discuss the evolving understanding of omega-3 fatty acids' effects on cardiovascular disease subtypes and their application in primary and secondary prevention.
• To address the controversies surrounding fish oil supplementation and its cardiovascular benefits.

Main Methods:

• Review of recent randomized controlled trials and clinical studies.
• Analysis of data from landmark trials including JELIS, VITAL, STRENGTH, ASCEND, and REDUCE-IT.
• Synthesis of evidence on prescription versus over-the-counter fish oil formulations.

Main Results:

• Icosapent ethyl demonstrated a significant reduction in cardiovascular mortality and ischemic events in patients with elevated triglycerides and established cardiovascular disease or diabetes.
• The REDUCE-IT trial highlighted the potential for further cardiovascular risk reduction in high-triglyceride patients on statin therapy.
• Conflicting results persist in some patient populations, necessitating a nuanced understanding of omega-3s' role.

Conclusions:

• Recent advancements, particularly with icosapent ethyl, offer new strategies for cardiovascular risk reduction in specific patient groups.
• A clearer picture is emerging regarding the benefits of omega-3 fatty acids, especially prescription forms, in managing cardiometabolic diseases.
• Further research and clinical evaluation are essential to optimize the use of fish oil derivatives in cardiovascular prevention.