Invited Commentary
May 2014

ω-3 Fatty Acids and Lutein + Zeaxanthin Supplementation for the Prevention of Cardiovascular Disease

Author Affiliations
  • 1Department of Internal Medicine and Lipid Disorders Clinic, University Hospital of Ioannina, Ioannina, Greece
  • 2Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece

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JAMA Intern Med. 2014;174(5):771-772. doi:10.1001/jamainternmed.2013.13734

The truth is rarely pure and never simple.

Mark Twain

ω-3 Polyunsaturated fatty acid supplements are increasingly used for the prevention of cardiovascular disease (CVD) either under a physician’s prescription or as over-the-counter products. They currently support a thriving industry with 2011 market sales of $25.42 billion, which grows by more than 15% annually.1 The main effect of ω-3 supplementation is the reduction of triglyceride (TG) levels, whereas additional suggested mechanisms for CVD protection are the prevention of serious arrhythmias, decrease of platelet aggregation, stabilization of atherosclerotic plaque, and reduction of blood pressure.2 Their effect on TG levels is dose dependent, and doses close to 4 g daily can decrease TG level by up to 25%. Although high TG levels have been traditionally considered a secondary target for CVD prevention, they are not incorporated in cardiovascular risk assessment tools. Thus, not surprisingly, the current guidance on ω-3 supplementation for CVD protection is controversial. The latest US guidelines focus on safety of nonstatin treatment and claim that in cases when nonstatin agents must be used, those with reported clinical benefit should be preferred.3 The Food and Drug Administration has approved their administration only as triglyceride-lowering agents for overt hypertriglyceridemia,4 whereas the European Medicines Agency has additionally approved ω-3 supplementation as an adjuvant treatment after myocardial infarction.5

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