Eicosapentaenoic acid vs. docosahexaenoic acid for the prevention of cardiovascular disease
Abstract
Purpose of review: Populations with greater fatty fish intake have lower risk of coronary heart disease. However, trials testing omega-3 fatty acids (FA) on cardiovascular outcomes have yielded inconsistent results. In this review, we summarize the major cardiovascular trials examining omega-3 FA supplementation, and compare differences with eicosapentaenoic acid (EPA) alone vs. docosahexaenoic acid (DHA) combined with EPA. Recent findings: The JELIS and REDUCE-IT trials both demonstrated significant reduction in cardiovascular events with high dose EPA in the form of icosapent ethyl (IPE), with a similar trend seen in the RESPECT-EPA trial. In contrast, the ASCEND, VITAL, STRENGTH, and OMEMI trials examining EPA+DPA combinations failed to demonstrate benefit. Beyond the difference in omega-3 FA formulations (IPE vs. omega-3 carboxylic acid), other differences between REDUCE-IT and STRENGTH include the achieved EPA levels, differing properties that EPA and DHA have on membrane stabilization, and the comparator oils tested in the trials. Summary: The totality of evidence suggests EPA alone, administered in a highly-purified, high-dose form, improves cardiovascular outcomes among patients with elevated triglycerides at high cardiovascular risk, but EPA and DHA together does not. Current guidelines endorse the use of IPE in statin-treated patients at high cardiovascular risk who have triglycerides >135 mg/dl.
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Simple fish oil omega-3 DHA and EPA are not helpful in the secondary prevention of cardiovascular disease compared with the prescribed IPE form.
“Furthermore, there has been data that simple fish oil-omega-3 docosahexaenoic acid (DHA) and EPA are not helpful in the secondary prevention of cardiovascular disease compared to the prescribed IPE form7.”
From Cardiovascular outcomes and coronary artery disease prevention secondary to icosapent ethyl: a meta-analysis of randomized clinical trials (2024) · cites this paper as [7]
Cites
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“All rights rese Copyright © 2023 Wolters Kluwe tested icosapentethyl (IPE) – ahighly-purified formof EPA – at a dose of 2g twice daily in patients on statintherapywith established ASCVDor diabeteswith one other cardiovascular risk factor who remained with elevated fasting TG levels >135mg/dl despite well controlled LD…”
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Sattar, Y., & Alraies, M. C. (2024) · Annals of Medicine & Surgery · doi:10.1097/ms9.0000000000002215 · Cited by 1 · see citing works
“Furthermore, there has been data that simple fi sh oil-omega-3 docosahexaenoic acid (DHA) and EPA are not helpful in the secondary prevention of cardio-vascular disease compared to the prescribed IPE form [7] .”
Background
- Authors
- Sweeney, T. E., Gaine, S. P., & Michos, E. D.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Michos, Erin D.
- Venue
- Current Opinion in Endocrinology, Diabetes & Obesity
- Published
- 2022-12-23
- Volume
- 30
- Issue
- 2
- Pages
- 87-93
- ISSN
- 1752-296X (ISSN-L)
- 1752-2978
- OpenAlex
- W4312113548
- Cited by
- 18
- References
- 13
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 6 · 2023: 4
- FWCI
- 0.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Endocrinology Diabetes and Obesity (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- eicosapentaenoic acid, docosahexaenoic acid, omega-3 fatty acids, cardiovascular disease prevention, icosapent ethyl, statin-treated patients, REDUCE-IT trial, ASCEND trial, VITAL trial, coronary artery disease
- MeSH terms
- Animals, Cardiovascular Diseases, Docosahexaenoic Acids, Humans, Triglycerides, Eicosapentaenoic Acid, Hypertriglyceridemia
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