Hypertriglyceridemia omega-3 fatty acids: Difference between revisions
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* EPA and DHA inhibits esterification of other fatty acids. | * EPA and DHA inhibits esterification of other fatty acids. | ||
===Advantages=== | ===Advantages=== | ||
Advantages seen with | Advantages seen with ≥3 grams/day [[eicosapentaenoic acid]] and [[docosahexaenoic acid]] (EPA/DHA) concentrate are | ||
* Decreased [[very low-density lipoprotein]] [[VLDL]] production | * Decreased [[very low-density lipoprotein]] [[VLDL]] production | ||
* Decreased serum triglyceride concentration by ≥ 50% | * Decreased serum triglyceride concentration by ≥ 50% | ||
===Side-effects=== | ===Side-effects=== | ||
* Dose dependent gastrointestinal side-effects like [[nausea]] (approximately 4 % of individuals at < 3 gm/d, and 20% at > 4gm/d experiences gastrointestinal side-effects)<ref name="pmid16825676">{{cite journal| author=Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B et al.| title=n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. | journal=Am J Clin Nutr | year= 2006 | volume= 84 | issue= 1 | pages= 5-17 | pmid=16825676 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16825676 }} </ref> | * Dose dependent gastrointestinal side-effects like [[nausea]] (approximately 4 % of individuals at < 3 gm/d, and 20% at > 4gm/d experiences gastrointestinal side-effects)<ref name="pmid16825676">{{cite journal| author=Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B et al.| title=n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. | journal=Am J Clin Nutr | year= 2006 | volume= 84 | issue= 1 | pages= 5-17 | pmid=16825676 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16825676 }} </ref> | ||
Revision as of 03:07, 3 October 2011
For full Omega-3 fatty acid drug info click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]
Overview
Treatment of hypertriglyceridemia is by restriction of carbohydrates and fat in the diet, as well as with niacin, fibrates and statins (three classes of drugs). Increased fish oil intake may substantially lower an individual's triglycerides.[1][2][3].
Omega-3 fatty acids
Mechanism of benefit
- Decreased hepatic lipogenesis
- Increased plasma lipoprotein lipase activity.
- Increased hepatic mitochondrial and peroxisomal beta-oxidation
- Inhibition of acyl CoA:1,2-diacylglycerol acyltransferase enzyme
- Omega-3 fatty acid's component eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) are poor enzyme substrates for triglyceride synthesis in the liver.
- EPA and DHA inhibits esterification of other fatty acids.
Advantages
Advantages seen with ≥3 grams/day eicosapentaenoic acid and docosahexaenoic acid (EPA/DHA) concentrate are
- Decreased very low-density lipoprotein VLDL production
- Decreased serum triglyceride concentration by ≥ 50%
Side-effects
- Dose dependent gastrointestinal side-effects like nausea (approximately 4 % of individuals at < 3 gm/d, and 20% at > 4gm/d experiences gastrointestinal side-effects)[4]
- The peculiar fishy smell can be a reason for discontinuation among many patients. This can be reduced by
- Freezing of medication
- Trying different medication preparation
- Taking medication with food
- Increased incidences of bleeding at high doses (According to FDA total intake up to 3 g per day of eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) comes under the category of "Generally Recognized As Safe" (GRAS). Large randomized trials are required to establish the association between omega-3 fatty acids and bleeding [4].
Sources
- Fatty fish (salmon,Herring), flaxseed, flaxseed oil, canola oil, soybean oil, and nuts.
Trial supportive data
Study on effect of combination of Omega-3 fatty acid and Simvastatin on hypertriglyceridemia [5]
- Source & year – Heart, 2001
- Study question – An omega-3 polyunsaturated fatty acid concentrate (Omacor) administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia
- Study Population and intervention – 59 patients with CHD, receiving simvastatin 10-40 mg daily with serum triglycerides > 2.3 mmol/l, were either given Omacor (84% omega-3 fatty acid) 2 g BD or placebo for 24 weeks
- Study design – Double blinded randomized controlled trial
- Study period – 1 year
- Study results – Combination of Simvastatin with Omacor compared with placebo or baseline resulted in:
- Decrease in serum triglycerides by 20-30% (p<0.005)
- Decrease in very low-density lipoprotein (VLDL) cholesterol by 30-40% (p<0.005)
- Study conclusion - Omacor combination with simvastatin (concentrated source of omega-3 fatty acids) was found to be a safe and effective in decreasing serum triglycerides level in a study over one year in coronary heart disease patients and hypertriglyceridemia
External links
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=184
References
- ↑ "Lipids Online Slides: hypertriglyceridemia, ICAM-1, fish oil, E-selectin".
- ↑ Terres W, Beil U, Reimann B, Tiede S, Bleifeld W (1991). "[Low-dose fish oil in primary hypertriglyceridemia. A randomized placebo-controlled study]". Zeitschrift für Kardiologie (in German). 80 (1): 20–4. PMID 2035283.
- ↑ "Fish oils in hypertriglyceridemia - Fish Oils Revisited Nutrition Research Newsletter - Find Articles".
- ↑ 4.0 4.1 Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B; et al. (2006). "n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review". Am J Clin Nutr. 84 (1): 5–17. PMID 16825676.
- ↑ Durrington PN, Bhatnagar D, Mackness MI, Morgan J, Julier K, Khan MA; et al. (2001). "An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia". Heart. 85 (5): 544–8. PMC 1729738. PMID 11303007.