CVD Benefits in Fish Oil: Is EPA the Pearl?

Carol Peckham; Howard S. Weintraub, MD


June 05, 2013

In This Article

Other Thoughts on Triglycerides

Medscape: What about lifestyle changes? Triglycerides are usually associated with obesity, right?

Dr. Weintraub: Granted, in many cases, lifestyle is the problem in patients with high triglycerides, so you ask the patient for a little help. Sometimes you get it and sometimes you don’t. Controlling sugar, watching their diet -- all the things that they can do to lose weight is the most effective approach. You can get a 20% reduction in triglycerides after dropping a few pounds, but that's one of the hardest things to do. Other behaviors help: stopping drinking and watching the kind of carbs you're eating. But do we just completely ignore a patient if his triglycerides are still 400? We're just going to turn our heads and walk away? I don't think that's a clever idea. When triglycerides are very high, things do not go well, so you also want medicines that work. However, you don't want to use 4 drugs to get it down. Therefore, I don't think that fish oil as a class is gone.

Medscape: So, if a patient comes in without high triglycerides and he's taking fish oil on his own, do you tell him to stop?

Dr. Weintraub: If you pool a bunch of cardiologists, internists, and even primary physicians and ask, "Do you use fish oil?" they'd probably say, "Well, you know, if someone wants to use it, it's okay." So, if you're on fish oil and you're tolerating it, then continue. However, would you instigate, provoke, or insist upon fish oil being used to prevent cardiovascular-related mortality and morbidity? The answer is probably no. If you're wondering whether you need it, the answer is also no. On the other hand, we don't have enough information in the dyslipidemic population, and particularly in people with triglycerides over 500, to say that fish oils are dead. That's where we are now.


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