Is Vascepa Or Lovaza More Effective
In a study comparing prescription omega-3 fatty acids, the authors concluded that these medications can significantly lower triglycerides to a comparable extent and are generally well-tolerated. Medications like Lovaza, which contain DHA, can increase LDL cholesterol, which can be troublesome for patients who are at high risk for cardiovascular disease. Vascepa only contains EPA and does not affect LDL levels.
Your healthcare provider can determine the most effective medication for you. Consult your healthcare provider for medical advice. He or she can decide if Vascepa or Lovaza is appropriate for you when considering your medical conditions and history and any medications you take that may interact with Vascepa or Lovaza.
Fish Oil And Triglycerides Research: A Closer Look
For example, a 2011 study from the University of South Dakotas Sanford School of Medicine found that 3.4 grams a day of fish oil reduce plasma TAGs by 25 to 50 percent.
And children consuming 4 grams of fish oil each day experienced an antithrombotic effect that slightly reduced their TAG levels, according to this 2014 study published in the Journal of Pediatrics. However, it did not affect their LDL particles.
Overall, however, the research is inconclusive. Why would the short-term studies show a lowering effect, while the most recent large cohort study shows the opposite result?
The large study, published in March 2021, challenges the claims of fish oils triglyceride-lowering power.
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Patients With Very High Tg Levels
An overview of pivotal clinical trials for each RxOM3FA in patients with very high TG levels is provided in Table 1.2,19,3234 Although there are no head-to-head clinical trials comparing all of the approved RxOM3FAs, it is informative to compare the results of these pivotal studies. At the end of treatment, statistically significant median TG reductions of approximately 12% to 52% compared with placebo were reported across these studies of RxOM3FAs .13,34 The observed range of TG lowering is likely due to substantial differences in baseline TG levels between studies .
Median Percent Changes From Baseline to Study End in Lipid Parameters Compared With Placebo in Studies of Patients With Very High Triglyceride Levels Receiving Prescription Omega-3 Fatty Acid Products
Lovaza 4 g/day: values represent . Statistical significance was not reported in pooled analysis in prescribing information but was reported in corresponding study publications.1,19,32,33 Vascepa 4 g/day: values represent the median of .34 Epanova 4 g/day treatment group: values represent the median of . P values were not reported in prescribing information but were reported in corresponding study publication.3,19 Omtryg 4 g/day: values represent the Hodges-Lehmann median of all pairwise differences from placebo.2 Lovaza 4 g/day : values represent the Hodges-Lehmann median of all pairwise differences from placebo.2
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Nordic Naturals Ultimate Omega D3
Nordic Naturals has put a lot of effort into name recognition: they take care to point out that their fish oil comes from deep sea fish , and that each batch is tested for toxin contents.
In addition to the Ultimate Omega D3, the company also offers a lower-priced product called simply Nordic Naturals Omega-3 Purified Fish Oil. The Ultimate version is definitely the one you want. It contains 685 mg of omega 3 per capsule, and 58% of the total fish oil in the product is DHA and EPA.
Genes Fish Oil And Triglycerides: An Unexpected Outcome
Researchers from the University of Georgia decided to test the hypothesis that our genetic makeup influences whether well benefit from fish oil supplementation.
To identify which genomic factors affect blood lipid levels, they conducted a genome-wide association study among participants of the UK Biobank.
The studys first stage included 73,962 of the UK Biobanks Caucasian genetic participants in the Biobank UK. The second stage gathered samples from 7,284 white participants in the ARIC group study.
The researchers looked at four fats. All were biomarkers of cardiovascular health:
- Genetics may have cast doubt on fish oil and triglyceride claims.
and triglycerides .
They divided the samples into two groups, those from about 11 thousand people taking fish oil supplements and the rest from participants not taking them.
And thats how they discovered that the results differed depending on a persons genes!
Their goal was to observe fish oils association with two main A and G genes. Participants had one of three genotypes:
The majority 92.1 percent were AA. Another 7.7 percent were AG. Only 0 .1 percent were GG.
What were the fish oil and triglycerides outcomes according to genotype?
- The AA group had higher TAGs than those not taking fish oil supplements.
- The AG group had lower TAGs than those not taking fish oil supplements.
- The GG group was so small that the researchers decided not to consider their TAG levels.
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American Heart Association News Stories
American Heart Association News covers heart disease, stroke and related health issues. Not all views expressed in American Heart Association News stories reflect the official position of the American Heart Association. Statements, conclusions, accuracy and reliability of studies published in American Heart Association scientific journals or presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect the American Heart Associations official guidance, policies or positions.
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Practical Pearls: Lowering Triglycerides With Omega
Approximately 27 percent of adult Americans have elevated fasting triglycerides .1 This commonly encountered dyslipidemia is an important indicator of the presence of atherogenic lipoprotein particles and may be considered a modifiable risk factor for cardiovascular disease.2 While genetic defects are responsible for familial forms of hypertriglyceridemia, secondary causes of hypertriglyceridemia often can be attributed to dietary factors , medications and certain disease states that alter lipid metabolism .3 These secondary causes should be addressed prior to or in conjunction with the implementation of corrective therapy , fibrates, niacin).
Two prescription versions of n-3 FA are currently available in the U.S. and have been shown to lower TG by 27 to 45 percent.6,7 In situations in which cost or drug formulary restrictions preclude their use, over-the-counter formulations may be used8 under the supervision of a lipid specialist.
Patients may inquire about krill oil because of the reported lack of fishy aftertaste, smaller capsule size and potential for lower pill burden since krill oil may have better bioavailability than fish oil.11
Shellfish allergies do not preclude the use of fish oil, although safety in this patient population has not been established.
Disclosure statement: There are no disclosures to report.
References are listed on page 34 of the PDF.
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Is Vascepa An Anti
The way that Vascepa works to lower triglycerides is not entirely understood but is likely to work in a number of ways. In 2018, Amarin Corporation, the manufacturer of Vascepa, released study results concluding that Vascepa reduced inflammatory markers in certain patients. However, Vascepa is not categorized as an anti-inflammatory drug.
Safety And Tolerability Of Rxom3fas
As a class, RxOM3FAs have a well-established safety profile.14 Although RxOM3FAs containing a combination of DHA and EPA are generally well tolerated, gastrointestinal symptoms may have implications for patient adherence .1,2 Epanova was associated with GI adverse events 3 despite the polyacrylate coating used to delay release in the gut and mitigate such side effects .38 The most commonly reported AE for the EPA-only product Vascepa was arthralgia there was no noted increase in the incidence of GI AEs compared with placebo .4 When considering AE data across RxOM3FA studies, it should be noted that different placebos were used: corn oil was used in the Lovaza studies, olive oil was used in the Epanova studies, and light liquid paraffin was used in the Vascepa studies.
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Dosages Of Omega 3 Fatty Acids
Dosage Forms and Strengths
Capsule
- Lovaza: 1g capsule contains at least 900 mg of ethyl esters of omega-3 fatty acids sourced from fish oils and includes eicosapentaenoic acid and docosahexaenoic acid
- Omtryg: 1.2g capsule contains at least 900 mg of ethyl esters of omega-3 fatty acids sourced from fish oils and includes eicosapentaenoic acid and docosahexaenoic acid
- Vascazen: 1g capsule contains at least 900 mg of ethyl esters of omega-3 fatty acids sourced from fish oils and includes eicosapentaenoic acid and docosahexaenoic acid
Dosage Considerations Should be Given as Follows:
Pediatric, children under 18 years: Safety and efficacy not established
Hypertriglyceridemia
This is not a complete list of side effects and other serious side effects may occur. Call your doctor for information and medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What Are Warnings And Precautions For Omega 3 Fatty Acids
Warnings
This medication contains omega 3 fatty acids. Do not take Lovaza, Vascazen, Omtryg, or Omega-3-acid ethyl esters if you are allergic to omega 3 fatty acids or any ingredients contained in this drug.
Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.
Contraindications
- See “What Are Side Effects Associated with Using Omega 3 Fatty Acids?”
Long-Term Effects
- See “What Are Side Effects Associated with Using Omega 3 Fatty Acids?”
Cautions
- Discontinue medications that exacerbate hypertriglyceridemia.
- Use caution in patients allergic to fish.
- May increase liver ALT witho ut increasing AST .
- May increase LDL levels .
- May prolong bleeding time .
- Recurrentatrial fibrillation or flutter observed when initial high dose of Lovaza administered .
Pregnancy and Lactation
- Use omega 3 fatty acids with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
- It is not known if omega 3 fatty acids are excreted in breast milk. Use caution if breastfeeding.
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The New Scientific Advisory Zeros In On Triglyceride Effects And On Newer Prescription
Prescription-strength omega-3 fatty acids, available at the US Food and Drug Administration-approved dose of 4 g/day, are a safe and effective treatment for reducing triglycerides among individuals with hypertriglyceridemia, according to a new scientific statement from the American Heart Association .
Before omega-3 fatty acids are prescribed, however, physicians should first address any potential secondary causes of high triglycerides, such as hyperthyroidism or poorly managed type 2 diabetes, as well as implement a strategy to modify diet and lifestyle.
If these changes are not possible or not effective, initiating triglyceride-lowering pharmacotherapy may be required, write Ann Skulas-Ray, PhD , and colleagues in a paper published online August 19, 2019, in Circulation.
The science advisory updates prior AHA documents focused on omega-3 fatty acids, dating back to 2002 and 2011, that predate the advent of purified, prescription-strength formulations. The document also focuses specifically on their effects on hypertriglyceridemia, rather than atherosclerotic vascular disease.
To TCTMD, Skulas-Ray stressed that the degree of treatment response to omega-3 prescriptions is determined by the severity of an individuals triglyceride levels prior to treatment. She also noted that levels are highly variable day-to-day, so the determination of response shouldnt be based on a single triglyceride measurement.
What To Look For In A Supplement
Dietary supplements arent regulated in the U.S., so its impossible to know just what youre getting when you pluck a bottle off the shelfunless it has USP Dietary Supplement Verification, which means the product has been tested to verify it contains what the label says it does. Just look for the USP seal on the label.
Choose an over-the-counter omega-3 supplement thats purified and contains EPA and DHA, says Robert Greenfield, M.D., a cardiologist at Memorial Care Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.
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British Columbia Specific Information
The BC Ministry of Health and BC Centre for Disease Control have developed recommendations that will help you and your family choose and eat fish that are low in mercury. To find out which fish are low, medium and high in mercury, see HealthLinkBC File #68m Food Safety: Mercury in Fish.
Additionally, BC oysters are high in cadmium. Health Canada recommends that adults eat a maximum of 12 BC oysters per month and that children eat a maximum of 1.5 BC oysters per month. For more information, see BCCDC â Cadmium in BC Shellfish.
What Causes An Omega
Omega-3 deficiency is usually caused by not consuming enough omega-3s through foods. However, most people in the U.S. get adequate amounts of omega-3s from dietary sources.
Some groups are at higher risk for an omega-3 deficiency, including people who restrict their dietary fat intake and those with eating disorders or other health conditions that cause malabsorption.
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Aha: Prescription Fish Oil Effectively Lowers High Triglycerides
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Four grams per day of omega-3 fatty acids, specifically eicosapentaenoic acid and docosahexaenoic acid together or eicosapentaenoic acid alone, is clinically useful as monotherapy or in addition to other therapies to reduce triglycerides after implementing diet and lifestyle changes and addressing any underlying causes, according to an American Heart Association science advisory published in Circulation.
From our review of the evidence from 17 randomized controlled clinical trials on high triglyceride levels, we concluded that treatment with 4 g daily of any of the available prescription choices is effective and can be used safely in conjunction with statin medicines that lower cholesterol,Ann C. Skulas-Ray, PhD, assistant professor in the department of nutritional sciences at The University of Arizona College of Agriculture and Life Sciences in Tucson and member of the writing group, said in a press release.
FDA-approved medications
Despite these benefits with omega-3 fatty acids, patients with very high triglycerides may need multiple mediations in addition to changes in lifestyle and diet to achieve acceptable triglyceride levels, according to the science advisory. Data are limited regarding the use of omega-3 fatty acids with nonstatin therapy for the treatment of these patients.
Mechanisms of triglyceride lowering
High Dose Recommended In Science Advisory
byNicole Lou, Staff Writer, MedPage Today August 20, 2019
Prescription omega-3 fatty acids are an “effective and safe option” to cut down triglycerides, according to a science advisory released by the American Heart Association .
However, over-the-counter omega-3 supplements are not reviewed or approved by the FDA and should not be used in place of prescription medication for the long-term management of high triglycerides, cautioned writing group chair Ann Skulas-Ray, PhD, of the University of Arizona, Tucson, in a press release.
Prescription omega-3 fatty acids “at a dose of 4 g/d, are clinically useful for reducing triglycerides, after any underlying causes are addressed and diet and lifestyle strategies are implemented, either as monotherapy or as an adjunct to other triglyceride-lowering therapies,” her group concluded.
Fish oil products containing eicosapentaenoic acid and/or docosahexaenoic acid taken at that dose have been shown to reduce triglyceride levels by at least 30% in patients with triglycerides of 500 mg/dL or greater, according to the statement published online in Circulation.
EPA-only formulations did not raise LDL cholesterol in this group, whereas combination EPA-DHA did, authors noted.
Among people with hypertriglyceridemia in the 200-499 mg/dL range, the 4-g/day dose of prescription omega-3 fatty acids lowered triglycerides by 20% to 30% without significantly increasing LDL cholesterol.
Disclosures
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Contraindications Warnings Precautions And Monitoring
The product labels for the DHA-containing RxOM3FAs state that LDL-C levels should be monitored periodically during therapy, as these products may increase LDL-C.13 For all the RxOM3FAs, the labels specify that alanine aminotransferase and aspartate aminotransferase levels should be monitored in patients with hepatic impairment and that the products should be used with caution in patients with known hypersensitivity to fish and/or shellfish.14 For Lovaza and Omtryg, the labels note a possible association with more frequent recurrences of symptomatic atrial fibrillation or flutter in patients with paroxysmal or persistent atrial fibrillation, particularly within the first months of initiating therapy.1,2
How They Lower Triglycerides
When you consume fish oil or other foods with omega-3s, key essential fatty acids get incorporated into your cells where they counteract the chemical breakdown of fats . Those lipids would eventually be delivered to your liver for further processing. Less fat going to your liver means less fat being packaged into triglycerides for the body use later on.
Omega-3s generally help the heart in other ways, too, lowering inflammation, counteracting blood clotting, and minimizing the buildup of plaque inside the arteries.
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