Revival of omega-3 fatty acids...4g high-dose recommended

4g high-strength dose a day recommended by KSoLA

KSoLA publishes the full version of the Korean Guidelines for the Management of Dyslipidemia

Specified omega-3's use, emphasizing use of high-purity ingredients and daily high-dose use

The Korean Society of Lipid and Atherosclerosis (KSoLA) disclosed the full version of its 5th edition of the Korean Guidelines for the Management of Dyslipidemia, in which the use of omega 3 was subdivided into the use of 'high dose and refined ingredients'.

 

Although there has been controversy over its efficacy, the new guideline puts weight on the fact that the benefits of its use still outweigh its non-use.

 

Annual Scientific Conference of the KSC with Affiliated Cardiac Societies

On the 22nd, the Annual Scientific Conference of the KSC with Affiliated Cardiac Societies that was organized by 8 academic societies including the Korean Society of Cardiology, the Korean Heart Rhythm Society, the Korean Society of Heart Failure, and KSoLA, announced the ‘2023 KSoLA Guideline Update,’ ‘Evidence of Guidelines,’ and ‘Limitations in the Evidence’ were announced.

 

A simplified version of the revised guidelines was announced last year, but this year, the full version was released to support its details and rationale.

 

The new changes made in the 5th version were ▲the Method of diagnosis and standards, ▲Treatment standards.

 

First, in the new diagnosis method and standard, the KSoLA showed the result that the non-fasting triglycerides level showed a high correlation with the risk of cardiovascular disease.

 

In the standards, patients with coronary artery disease were recommended to lower their LDL cholesterol target level from less than 70 mg/dL to less than 55 mg/dL and lower it by more than 50% from baseline.

 

In the case of patients with diabetes, the target goal is less than 70 mg/dL for patients with a disease duration of 10 years or more, one or more additional risk factors, or target organ damage, depending on the risk level.

 

In addition, diabetic patients with 3 or more target organ damage or major cardiovascular disease risk factors can selectively consider reducing LDL cholesterol to less than 55 mg/dL.

 

Furthermore, as exercise therapy, the recommendation grade for the use of wearables for fitness was newly presented as IIa, and additionally methods for using wearable equipment and a strategy for promoting physical activity were suggested.

 

In the full version, society took a somewhat reserved position on the use of Omega 3, which was plagued by controversy over its cardiovascular protective effect.

 

Professor Ye-Seul Yang (Endoctrioinology, SNUH), who presented on the 'New Changes on the KSoLA Guidelines,’ said, “The 5th edition of the revised guidelines segmented and reinforced the treatment criteria and treatment targets for dyslipidemia.

 

The new guideline recommended different treatment standards by subdividing diabetes by risk group." Yang said, “Individualized guidelines were set according to specific groups such as those with stroke, chronic kidney disease, the elderly, adolescents, and familial hypercholesterolemia.

 

In terms of drug therapy, the recommended grade was raised to emphasize that statins are a first-line treatment drug, and introduced icosapent ethyl(IPE) and the role of fibrate and omega-3 fatty acids in managing triglyceride.” As for whether omega 3 actually shows a protective effect against cardiovascular disease, large-scale studies have come to different conclusions.

 

The most recent study that proved its efficacy observed an effect when only the IPE component was isolated from the omega-3 and used in high dosages.

 

The KSoLA newly included the use of IPE in the recommendation for patients with atherosclerotic cardiovascular disease or diabetes who still have hypertriglyceridemia even after LDL cholesterol is controlled below the target level with statins.

 

In the treatment of hypertriglyceridemia, "Use of fibric acid derivatives or omega-3 fatty acids that mainly lower triglycerides first are recommended as a priority (IIa, A), and even after achieving LDL cholesterol below the target level through therapeutic lifestyle improvement and statin drug treatment, if the triglyceride is 200 mg/dL or higher or the non-HDL cholesterol level is higher than the target value, drug treatments to lower the triglyceride can be considered (IIa, B)." KSoLA said, "In the recent REDUCE-IT study, 4g of IPE was administered per day in patients at high risk of atherosclerotic cardiovascular disease or diabetes, which reduced the incidence of cardiovascular disease by 26% compared to placebo.

 

If hypertriglyceridemia persists in high-risk patients at a 200 mg/dL or higher level even after lifestyle improvement and statin administration, additional IPE (4g per day) can be administered to prevent cardiovascular disease (IIb, B)." However, KSoLA added a provision on account of the controversy in place.

 

KSoLA added, “The effect of omega-3 fatty acids on reducing the risk of cardiovascular disease is still in controversy because of the varying results shown depending on formulation or dosage.

 

In the recent REDUCE-IT study that was conducted in patients at high risk of cardiovascular disease whose triglyceride levels were higher than 135-499 mg/dL, the use of IPE, a high-purity EPA, twice a day significantly reduced death from cardiovascular disease and the occurrence of ischemic disease." “In the European practice guidelines that were revised in 2019, control of triglyceride using IPE was recommended for patients at high risk of cardiovascular disease, however, IPE is not being sold in the market yet.

 

Also, in another recent study, the STRENGTH study, the combination of EPA and DHA did not show any benefit in cardiovascular disease, but rather increased the risk of atrial fibrillation compared to the control group." Also, the guidelines emphasized the need to use a high-dose high-purity ingredient for the combined use of statin and Omega 3.

 

KSoLA said, “Combination therapy can be used to reduce LDL cholesterol and triglyceride at the same time.

 

"The combination of 4 g of Omega 3 per day with simvastatin significantly decreased triglyceride and slightly increased HDL cholesterol."