“2023 Meta-analysis (N=29,913) shows Omega-3s (specifically EPA) significantly reduce myocardial infarction, cardiovascular death, and all-cause mortality.”
Some quick caveats:" Among patients with elevated triglyceride levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower among those who received 2 g of icosapent ethyl twice daily than among those who received a placebo."
25% relative risk reduction with a 4.8% absolute risk reduction; number needed to treat = 21 JACC
REDUCE-IT used 4 g/day of pure EPA as icosapent ethyl (Vascepa), with zero DHA. Specifically, 2 g twice daily of icosapent ethyl, which is the ethyl ester form of EPA only.
Great if you don’t bleed to death first or develop AFib. There is a reason it is by prescription.
If it takes a 25% relative risk reduction with a 4.8% absolute risk reduction at 4 grams of prescription EPA each and every day, you are probably wasting your money taking significantly less. If you are taking ordinary Omega-3s that contain EPA at doses high enough to equal the amount of EPA in the studies, you are also getting a very significant amount of DHA, which can increase your LDL. High-dose DHA could partially offset the lipid benefits you’re getting from your statin.
Claude Opus 4.7:
“In plain terms: over roughly 5 years, treating 21 high-risk patients with 4 g/day icosapent ethy) prevents one of them from having a major cardiovascular event. Put another way, the event rate dropped from roughly 22% to 17% over those 5 years — so out of 100 similar patients, about 5 fewer had an event.”
Addendum:
What’s clearly true:
The major positive trials in this space have significant industry ties:
REDUCE-IT was funded by Amarin Pharma, the manufacturer of Vascepa (icosapent ethyl). Amarin’s stock price was directly tied to the trial outcome. The lead investigator (Deepak Bhatt) and many co-authors have received consulting fees and research support from Amarin.
STRENGTH was funded by AstraZeneca, manufacturer of Epanova (the mixed EPA/DHA formulation being tested). When the trial showed no benefit, AstraZeneca discontinued the product within months.
JELIS (2007, Japanese EPA trial showing CV benefit) was funded by Mochida Pharmaceutical, which sold the EPA preparation tested.
VITAL (the large NIH-funded omega-3/vitamin D trial) was an exception — government-funded — and it was largely null for the primary CV endpoint.
Most meta-analyses pooling these trials are conducted by authors with disclosed industry relationships.