New drug is a highly purified fish oil

Dear Dr. Roach: I recently saw an ad on TV for Vascepa. It seems to be a drug for lowering triglycerides. I did some additional research and found that it also works as an anti-inflammatory. My triglycerides on my last bloodwork were 160. Would this drug be of benefit for me? Some say it’s merely fish oil. I wonder if it’s just a higher octane of fish oil, so to speak.

B.

Answer: Before taking a medication, it should be very clear what the goals of the medication are. This is true whether the medicine is prescription, over-thecounter, vitamin or other supplement.

In the case of people with high triglycerides, the goal of omega-3 fish oil is preventive. For people with VERY high triglycerides (over 885 mg/dL), reducing triglycerides reduces the incidence of inflammation of the pancreas. That is not a concern for you; in your case, the goal is to reduce the likelihood of having a heart attack or stroke.

Vascepa is a highly purified omega-3 fish oil ester. It was shown in a study to reduce risk of the combination of cardiac death, heart attack and stroke in people with elevated triglyceride levels (135-500) AND a history of coronary artery disease OR diabetes and an additional risk factor such as high blood pressure, evidence of blood inflammation or peripheral artery disease. In this group of high-risk subjects, Vascepa reduced the risk of developing one of the endpoints from 22% to 17%.

If you are considering taking a fish oil supplement because you are at higher risk for heart disease or stroke, a statin drug is a much better studied mechanism to reduce that risk. If your triglycerides remain elevated despite statin therapy, then Vascepa is a good idea if you fall into a high-risk group. I would recommend Vascepa, in this instance, rather than an over-the-counter fish oil supplement, due to the good-quality evidence of benefit and the concern that some brands of OTC supplements are not of excellent quality.

Eating fatty fish one or two servings a week gives many of the benefits of fish oil supplementation.