Studies show that patients with elevated
triglycerides and well-controlled
LDL levels under
statin therapy still have a significant residual risk of cardiovascular (CV) events. Despite many attempts to reduce
triglycerides with different
hypolipidemic drugs, no therapeutic option has given satisfactory results so far. The initial enthusiasm that
omega-3 fatty acids can effectively reduce
triglycerides and CV risk was replaced with skepticism when the first large clinical trials failed to show any benefit in primary or
secondary prevention. However, the latest studies succeeded in showing a positive effect of
omega-3 fatty acids on CV outcome in patients with
hypertriglyceridemia. The largest benefit was reported in secondary but not primary prevention. Interestingly, the reduction in
triglycerides in some of these studies was disproportionately low to the relatively high CV risk reduction, which could indicate some other effects of
omega-3 fatty acids that go well beyond hypotriglyceridemic action. This includes blood pressure reduction, antithrombotic effect, improvement of inflammatory status, endothelial function, and
insulin resistance. Investigations also reported a significant and positive influence of
omega-3 fatty acids on the composition and stabilization of coronary
atherosclerotic plaques in patients with and without previous CV events. In addition to insufficiently known mechanisms of action and conflicting results about the effectiveness of
omega-3 fatty acids, the safety problems, which include increased prevalence of
atrial fibrillation and
hemorrhage, were also reported. The aim of this clinical review was to summarize the current knowledge regarding the use of
omega-3 fatty acids in CV patients, particularly those with
coronary artery disease, and to present an overview of key clinical trial data.