Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association
Skulas-Ray AC, Wilson PWF, Harris WS, Brinton EA, Kris-Etherton PM, Richter CK, Jacobson TA, Engler MB, Miller M, Robinson JG, Blum CB, Rodriguez-Leyva D, de Ferranti SD, Welty FK, American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology
Circulation · 365 citas
Cómo se estudió
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- Eventos clínicos como enfermedad o muerte
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- Financiación
- Financiación independiente
- Gobierno
- U.S. Department of Defense
- Gobierno
- U.S. Department of Health and Human Services
- Gobierno
- National Institutes of Health
Según 3 financiadores declarados.
Publicación
- Publicado
- 2019-08-19 · Circulation · vol. 140 · número 12 · págs. e673–e691
- Editorial
- Lippincott Williams & Wilkins
- Citado
- 487 citas · más que el 100% de estudios similares · 31.6× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 120 trabajos
- Acceso
- Lectura gratuita
- Áreas de investigación
- Fatty Acid Research and Health · Lipid metabolism and disorders · Diabetes, Cardiovascular Risks, and Lipoproteins
- Palabras clave
- Hypertriglyceridemia, Medicine, Triglyceride, Eicosapentaenoic acid, Docosahexaenoic acid, Internal medicine, Endocrinology, Cholesterol, Diabetes mellitus, Fatty acid, Biochemistry, Polyunsaturated fatty acid, Chemistry
- MeSH
- humans, cardiovascular diseases, hypertriglyceridemia, fatty acids, omega-3, triglycerides, risk, american heart association, united states, atherosclerosis, clinical trials as topic
14 autores
- Ann C. Skulas‐Ray🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- Peter W.F. Wilson🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- William Stephen Harris🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- Eliot A. Brinton🇳🇴🇺🇸🇬🇧Unifor; Uniformed Services University of the Health Sciences; George Eliot Hospital
- Penny M. Kris‐Etherton🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences; Penny George Institute for Health and Healing
- Chesney K. Richter🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- Terry A. Jacobson🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences; Jacobs (United States)
- Mary B. Engler🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- Michael J. Miller🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- Jennifer G. Robinson🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- Conrad B. Blum🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- Delfin Rodriguez–Leyva🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- Sarah D. de Ferranti🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
- Francine K. Welty🇳🇴🇺🇸Unifor; Uniformed Services University of the Health Sciences
Resumen
El texto original del estudio, en el idioma en que se publicó.
Hypertriglyceridemia (triglycerides 200-499 mg/dL) is relatively common in the United States, whereas more severe triglyceride elevations (very high triglycerides, ≥500 mg/dL) are far less frequently observed. Both are becoming increasingly prevalent in the United States and elsewhere, likely driven in large part by growing rates of obesity and diabetes mellitus. In a 2002 American Heart Association scientific statement, the omega-3 fatty acids (n-3 FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were recommended (at a dose of 2-4 g/d) for reducing triglycerides in patients with elevated triglycerides. Since 2002, prescription agents containing EPA+DHA or EPA alone have been approved by the US Food and Drug Administration for treating very high triglycerides; these agents are also widely used for hypertriglyceridemia. The purpose of this advisory is to summarize the lipid and lipoprotein effects resulting from pharmacological doses of n-3 FAs (>3 g/d total EPA+DHA) on the basis of new scientific data and availability of n-3 FA agents. In treatment of very high triglycerides with 4 g/d, EPA+DHA agents reduce triglycerides by ≥30% with concurrent increases in low-density lipoprotein cholesterol, whereas EPA-only did not raise low-density lipoprotein cholesterol in very high triglycerides. When used to treat hypertriglyceridemia, n-3 FAs with EPA+DHA or with EPA-only appear roughly comparable for triglyceride lowering and do not increase low-density lipoprotein cholesterol when used as monotherapy or in combination with a statin. In the largest trials of 4 g/d prescription n-3 FA, non-high-density lipoprotein cholesterol and apolipoprotein B were modestly decreased, indicating reductions in total atherogenic lipoproteins. The use of n-3 FA (4 g/d) for improving atherosclerotic cardiovascular disease risk in patients with hypertriglyceridemia is supported by a 25% reduction in major adverse cardiovascular events in REDUCE-IT (Reduction of Cardiovascular Events With EPA Intervention Trial), a randomized placebo-controlled trial of EPA-only in high-risk patients treated with a statin. The results of a trial of 4 g/d prescription EPA+DHA in hypertriglyceridemia are anticipated in 2020. We conclude that prescription n-3 FAs (EPA+DHA or EPA-only) at a dose of 4 g/d (>3 g/d total EPA+DHA) are an effective and safe option for reducing triglycerides as monotherapy or as an adjunct to other lipid-lowering agents.
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