Article Text

  1. M. Gandhi,
  2. V. Aligeti,
  3. R. Braden,
  4. A. Rezk,
  5. M. B. Elam
  1. Department of Medicine and Pharmacology, VA Medical Center and University of Tennessee, Memphis, Memphis, TN


Background Fish oil supplements are administered for treatment of hypertriglyceridemia, frequently in combination with other lipid-lowering agents. Given the presence of overlapping mechanisms of action of N-3 polyunsaturated fatty acids with that of other lipid-lowering agents, in particular fibrates, the efficacy of fish oil may be diminished with concomitant administration of other lipid-lowering agents.

Objective To determine the efficacy (primarily triglyceride lowering) of fish oil supplements when co-administered with other lipid-lowering agents versus that of fish oil alone.

Design/Setting Retrospective chart review. Outpatient clinics of large Gov. HMO (VA, Memphis).

Patients Representative population of veterans attending outpatient clinics with active prescription for fish oil supplements at the time of survey, who had lipid profiles prior to and following initiation of fish oil.

Results Over 500 individuals receiving fish oil supplements were identified. Of these, 94 individual patients had the required information available and were therefore evaluable for this study. Forty-eight were receiving fish oil alone and 46 had fish oil added to another hypolipidemic agent(s) (statin, fibrate, niacin). The average dose of fish oil administered in both groups was relatively low (3.2 and 3.3 grams per day in fish oil only and fish oil added groups), indicating use of relatively low doses of fish oil in many patients. Despite this, fish oil therapy effectively reduced triglyceride and to an equal extent in the fish oil only and fish oil added groups (228% versus 224% respectively, p = .24). Analysis of triglyceride response by type of lipid-lowering agent administered showed no significant attenuation of fish oil efficacy with concomitant administration of statin, niacin, or fibrate.

Limitations A limited number of evaluable cases were identified. The study was not prospective or randomized. A limited effect of other hypolipidemic agents on triglyceride response to fish oil supplements may have gone undetected; however, the present study supports the hypothesis that fish oil supplements are effective when added to other hypolipidemic agents.

Conclusions Fish oil supplements effectively reduce plasma triglyceride when administered alone or with concomitant lipid-lowering therapy. Submaximal doses of fish oil supplements are frequently used in this outpatient practice setting, thereby limiting the benefit gained.

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