Do omega-3s add cardiovascular benefits to statin therapy? Original paper

In this meta-analysis of randomized controlled studies, adding omega-3 fatty acids to statin therapy reduced the incidence of several types of cardiovascular events and improved blood lipid levels compared to statin therapy alone.

The effectiveness of omega-3 fatty acids and statin therapy compared to statin therapy alone on cardiovascular events, including myocardial infarction (MI), stroke, coronary revascularization, death due to cardiovascular disease, major adverse cardiovascular events (MACE), hospitalization due to unstable angina, and lipid volume index.

Secondary outcomes included blood lipids (i.e., LDL-C, HDL-C, total cholesterol, triglycerides), C-reactive protein (CRP), EPA levels, and the ratio of EPA to arachidonic acid (AA).

A total of 40,991 adults (average age of 65).

A meta-analysis of 14 randomized controlled trials was conducted. The dosage of omega-3 fatty acids was 930–4,000 mg per day (average dosage of 1,800 mg per day).

In the omega-3+statin group, there was a lower risk for the incidence of MI (−28%), MACE (−15%), unstable angina (−25%), and hospitalization due to unstable angina (−25%) compared to the participants receiving a placebo + a statin.

The omega-3+statin group had higher serum EPA levels, lower total cholesterol levels, lower triglycerides, lower CRP levels, a higher EPA/AA ratio, and a lower lipid volume index compared to the participants receiving a placebo + statin. These results all represent improvements.

The EPA/AA ratio is a marker of chronic inflammation and a valuable predictor of cardiovascular risk, with a higher ratio representing lower levels of inflammation. This is because the anti-inflammatory EPA competes with the proinflammatory AA for key enzymes in the body which, as a result, form fewer inflammatory products.^[1]