The fish oil story


This led to articles and studies in the 1990s claiming that if people took fish oil pills in these circumstances, heart health would improve. The GISSI study published in 1999 had the results to prove it.3 Soon the effects of fish oil pills were exaggerated and touted as miracle pills.

People started eating more fish and healthy oils. The results of the Mediterranean Diet became available and encouraged olive oil consumption. Statin use also increased, and artificial margarines and low-fat diets fell out of favor.

Results from recent studies show that there are no benefits from taking fish oil pills, probably because many people are now getting healthy oils from their diet4

In a recent meta-analysis, researchers wanted to use 10 large, randomized control studies to shed light on what was going on (Table 1).

All participants were at high risk for cardiovascular disease. Of the participants, 61.4% were men and the median age at entry was 64 years. The trials lasted an average of 4.4 years. Various dosages of fish oil with eicosapentaenoic acid (EPA) levels ranging from 226 to 1800 mg / day were used.

The researchers investigated whether fish oils prevented all-cause mortality, fatal coronary artery disease, serious vascular events, non-fatal myocardial infarction, and stroke. They concluded that omega-3 fatty acids had no significant association with fatal or non-fatal coronary heart disease or major vascular events. The study results do not support current recommendations for the use of such supplements in people with a history of coronary artery disease.

Regardless of how investigators analyzed and dissected the data, they found that no one really benefited from using fish oil for heart health purposes. This population included people with a history of coronary artery disease, diabetes, elevated lipid levels, or statin use. Unfortunately, investigators did not have data to analyze whether fish oils helped smokers but provided limited analysis of the subgroups based on the data available.

In the JELIS study only EPA and no docosahexaenoic acid (DHA) was used. This study had such positive results that the data were excluded from this meta-analysis.5 EPA has been isolated and has shown promise for lowering triglycerides.6 Icosapent, an EPA-only drug, has already been approved by the FDA to treat triglycerides in patients with higher concentrations cutting 500 mg / dl, you triple the normal value. 6

Mixtures containing both DHA and EPA can increase low-density lipoprotein cholesterol in patients with severe hypertriglyceridemia. However, study results suggest that EPA alone does not produce this negative effect.7,8

Future studies will show whether triglycerides are just markers of good health, or whether lowering triglycerides to normal levels leads to better health outcomes, fewer heart attacks and strokes, and longer lifespan.

Fish oils are a type of polyunsaturated fatty acid (PUFA). They are the omega-3 and omega-6 fatty acids. In terms of heart health, the active ingredients in fish oils are DHA and EPA. The hypothesis is that omega-3s provide protection against cardiovascular disease by reducing the heart’s susceptibility to arrhythmias, reducing platelet aggregation, and lowering blood pressure and triglyceride levels (Table 2). 9

The role of all PUFAs in disease prevention and general health is explored. In the future, practitioners can expect medical research investigating the effects of PUFA on the following health conditions: age-related macular degeneration, Alzheimer’s disease, cognitive function and dementia, attention deficit / hyperactivity disorder, cancer prevention through anti-inflammatory effects, childhood allergies, cystic fibrosis, depression, illness dry eye, child health and development, inflammatory bowel disease and rheumatoid arthritis.

Gunda Siska, PharmD, is a hospital pharmacist who helps doctors and nurses administer, dispense, and prescribe drugs, and independently dose and monitor highly hazardous and toxic drugs.


  • Harris WS. Omega-3 fatty acids. In: Coates PM, Betz JM, Blackman MR, et al., Eds. Encyclopedia of Dietary Supplements. 2nd ed. London, Great Britain and New York, NY: Informa Healthcare; 2010: 577- 586.
  • Temple NJ. Fat, Sugar, Whole Grains, and Heart Disease: 50 Years of Confusion. Nutrient. 2018; 10 (1): E39. doi: 10.3390 / nu10010039.
  • Food supplement with polyunsaturated n-3 fatty acids and vitamin E after myocardial infarction: results of the GISSI prevention study. Italian group to study myocardial infarction survival. Lancet. 1999; 354 (9177): 447- 455.
  • Aung T., Halsey J., Kromhout D. et al .; Cooperation between omega-3 treatment attempters. Associations of the use of omega-3 fatty acid preparations with cardiovascular diseases risk a meta-analysis of 10 studies with 77,917 people. JAMA Cardiol. 2018; 3 (3): 225-250; 234. doi: 10.1001 / jamacardio.2017.5205.
  • Yokoyama M., Origasa H., Matsuzaki M. et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolemic patients (JELIS): a randomized, open, blinded endpoint analysis. Lancet. 2007; 369 (9567): 1090- 1098. doi: 10.1016 / S0140-6736 (07) 60527-3.
  • Vascepa [prescribing information]. Bedminster, NJ: Amarin Pharma Inc; 2012. Accessed October 26, 2018.
  • Bays HE, Ballantyne CM, Kastelein JJ. Ethyl eicosapentaenoate (AMR101) therapy in patients with very high triglyceride levels (from the multicentre, placebo-controlled, randomized, double-blind 12-week open-label study [MARINE] Attempt). At J Cardiol. 2011; 108 (5): 682- 690. doi: 10.1016 / j.amjcard.2011.04.015.
  • Miller M., Stone NJ, Ballantyne et al. Triglycerides and Cardiovascular Disease: A Scientific Opinion from the American Heart Association. Traffic. 2011; 123 (20): 2292- 2333. doi: 10.1161 / CIR.0b013e3182160726.
  • National Health Institute. Omega-3 Fatty Acids Fact Sheet for Health Professionals. US Department of Health website. Updated June 6, 2018. Accessed October 26, 2018.


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