Some scientific organizations in the field of cardiovascular disease (CVD) prevention recommend pure EPA (without DHA) supplements for those who have high fasting (!) blood triglyceride levels and additional CVD risk factors. The following table (by Quispe et al. 2022) provides examples.
The EPA supplements used in the studies that these recommendations are based on used non-vegan "pure EPA" (referred to as IPE) supplements. IPE stands for "icosapent ethyl" which is EPA in a highly purified ethyl ester form (Quispe et al. 2022).
Not many vegan pure EPA supplements (without DHA) are available. But the triglyceride lowering effect can possibly also be achieved with EPA/DHA supplements, and vegan EPA/DHA supplements (made with microalgae oil) are commonly available.
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Summary of guideline recommendations [which suggest that these individuals should take IPE] |
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Professional society |
Recommendation |
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National Lipid Association (NLA) [Oringer et al. 2019] |
• 45 years old with clinical ASCVD or 50 years old with
diabetes mellitus requiring medication + 1 or more additional risk factors * |
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• TG 135–499 mg/dL |
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European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) [Mach et al. 2020] |
• Patients with high- and very high-risk on statin therapy |
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• TG 135–499 mg/dL |
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American Diabetes Association (ADA) [ADA 2021] |
• Patients with diabetes mellitus and ASCVD/other risk factors on
statin therapy and controlled LDL-C |
|
• TG 135–499 mg/dL |
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American Association of Clinical Endocrinologists (AACE) [Garber et al. 2020] |
• Patients with high-risk on maximally tolerated statin therapy |
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• TG 135–499 mg/dL |
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* Additional risk factors: age (men: ≥55, women: ≥65 years), cigarette smoker or stopped smoking within 3 months, hypertension (treated or untreated), HDL-C ≤40 mg/dL for men or ≤50 mg/dL for women, hs-CRP >3.0 mg/L, renal dysfunction with creatinine clearance >30 and <60 mL/min, retinopathy, micro- or macro-albuminuria, ankle-brachial index <0.9 without symptoms of intermittent claudication (Oringer et al. 2019)
Abbreviations: ASCVD, atherosclerotic cardiovascular disease; LDL-C: LDL cholesterol (i.e., "bad cholesterol"); TG: triglycerides
Does this also work with EPA/DHA supplements?
"At present it is unknown whether high dosage (3–4 g/d) [i.e., 3000–4000 mg/day] EPA and DHA combination therapy will produce similar results to that of high dosage (3–4 g/d) IPE [IPE is pure EPA] [...]." (Oringer et al. 2019)How much EPA/DHA would be recommended?
Mach et al. actually refer to the amount of EPA/DHA rather than EPA only: "[...] the dose required to decrease plasma TGs [triglycerides] is >2 g/day. [they recommend 2000–3000 mg of EPA/DHA]. [...] Pharmacological doses of long-chain n-3 fatty acids [EPA/DHA] (2–3 g/day) reduce TG levels by about 30% and also reduce the post-prandial lipaemic response, but a higher dosage may increase LDL-C ["bad cholesterol"] levels." (Mach et al. 2020)
References
Quispe et al.: Controversies in the Use of Omega-3 Fatty Acids to Prevent Atherosclerosis. Curr Atheroscler Rep. 2022 Jul;24(7):571-581. doi: 10.1007/s11883-022-01031-9. Epub 2022 Apr 30.Mach et al.: 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1;41(1):111-188. doi: 10.1093/eurheartj/ehz455.
Orringer et al.: National Lipid Association Scientific Statement on the use of icosapent ethyl in statin-treated patients with elevated triglycerides and high or very-high ASCVD risk. J Clin Lipidol. 2019 Nov-Dec;13(6):860-872. doi: 10.1016/j.jacl.2019.10.014. Epub 2019 Nov 2.
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