Omega-3 Fatty Acids in Cardiovascular Disease and Diabetes: a Review of Recent Evidence

Salman Bhat; Sudipa Sarkar; Duha Zaffar; Paresh Dandona; Rita R Kalyani

doi:10.1007/s11886-022-01831-0

Omega-3 Fatty Acids in Cardiovascular Disease and Diabetes: a Review of Recent Evidence

Curr Cardiol Rep. 2023 Feb;25(2):51-65. doi: 10.1007/s11886-022-01831-0. Epub 2023 Feb 2.

Authors

Salman Bhat¹, Sudipa Sarkar¹, Duha Zaffar², Paresh Dandona³, Rita R Kalyani⁴

Affiliations

¹ Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Internal Medicine, University of Maryland Midtown Campus, Baltimore, MD, USA.
³ Division of Endocrinology, Diabetes and Metabolism, University at Buffalo, Buffalo, NY, USA.
⁴ Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. rrastogi@jhmi.edu.

PMID: 36729217
DOI: 10.1007/s11886-022-01831-0

Abstract

Purpose of review: Omega-3 fatty acids (n-3 FA) lower triglycerides, have anti-inflammatory properties, and improve metabolism. Clinical evidence of cardiovascular benefit with omega-3 fatty acids is mixed. We discuss mechanisms providing biological plausibility of benefit of omega-3 fatty acids in cardiovascular risk reduction and review clinical trials investigating the benefits of prescription omega-3 fatty acids in dyslipidemia, atherosclerotic cardiovascular disease (ASCVD), and diabetes.

Recent findings: Although early trials showed no benefit of omega-3 fatty acids in ASCVD, the REDUCE-IT trial noted significant risk reduction in ASCVD events with highly purified EPA (icosapent ethyl) use which has changed the landscape for currently available therapeutic options. However, other large trials like STRENGTH and VITAL, which used different formulations of prescription omega-3 fatty acids, did not note significant cardiovascular risk reduction. Thus the effectiveness of omega-3 fatty acids for cardiovascular disease prevention is an ongoing topic of debate. A relative paucity of studies examining benefits for glycemic outcomes in persons with diabetes exists; however, few studies have suggested lack of benefit to date. Significant residual cardiovascular risk exists for individuals with hypertriglyceridemia. Prescription omega-3 fatty acids are more commonly used for CV risk reduction in these patients. Clinical guideline statements now recommend icosapent ethyl use for selected individuals with hypertriglyceridemia to reduce cardiovascular events given recent evidence from the REDUCE-IT trial. Nonetheless, data from other large scale trials has been mixed, and future research is needed to better understand how different preparations of omega-3 may differ in their cardiovascular and metabolic effects, and the mechanisms for their benefit.

Keywords: Atherosclerotic cardiovascular disease; Coronary artery disease; Diabetes mellitus; Eicosapentanoic acid; Fish oil; Omega 3 fatty acids.

Publication types

Review

MeSH terms

Atherosclerosis* / drug therapy
Cardiovascular Diseases* / drug therapy
Diabetes Mellitus* / drug therapy
Fatty Acids, Omega-3* / therapeutic use
Humans
Hypertriglyceridemia* / complications
Hypertriglyceridemia* / drug therapy
Triglycerides

Substances

Fatty Acids, Omega-3
Triglycerides