Effect of omega-3 fatty acids in statin users and statin non-users
In the Alpha Omega Trial the high risk group of patients who did not receive statins, got an additional amount of 400 mg/day EPA-DHA plus 2 g/day ALA and had 54% fewer major cardiovascular events than those who received placebo after 40 months of follow-up. In contrast, the rate of events were similar in the omega-3 fatty acids and placebo groups among those who took statins. These results underline the interference between statins and omega-3 fatty acids, and contribute to the explanation of the inconsistent results regarding omega-3 fatty acids between recent and earlier published secondary prevention trials.
Implications
Current guidelines recommend statin treatment for all patients with established cardiovascular diseases, unless their LDL cholesterol level is below 2.5 mmol/l. In the Alpha Omega Trial, 86% of statin non-users had an LDL cholesterol level exceeding 2.5 mmol/l – indicating considerable undertreatment. One could argue that when guidelines are followed more closely, additional use of omega-3 fatty acids is redundant. However, for the subset of patients in our trial who did not receive statins or who did not reach cholesterol target levels, additional omega-3 fatty acids may be an attractive option to reduce cardiovascular events.