The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
it showed a 25% reduction in risk for overall cardiovascular events over about a four or five year period which is not that long and it was effective across you know myocardial infarction need for angioplasty a variety of different cardiovascular unfortunate outcomes
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high-dose epa two grams twice a day with food because it is an ethyl ester theoretically it needs to be esterified before it's absorbed there was almost a 30 residual risk reduction that's mind-boggling to be on after taking a statin
lo and behold the first trial that started to come down the pike was done in japan said god probably almost a decade ago to japan epa trial you know japanese people eat a lot of omega-3s so they have higher baseline levels anyway so they just gave them for whatever reason epa only on top of a statin and they didn't necessarily have to have high triglycerides but many of the people did and lo and behold although it was not a blinded trial the evidence was pretty good that wow this is really plausible that epa at a high dose four grams a day reduces macrovascular outcomes when given with a statin
like in the reduced study 25 to 30 reduction in cardiovascular events and all cause mortality even in in people especially if they have triglycerides above 150.
a very interesting study published probably about 18 months ago that looked at a very high dose of epa four grams in individuals with elevated triglycerides and a number of other risks and i have to be honest with you too my surprise produced kind of an amazing outcome
the reduced investigators decided to go ahead and run a large multi-center trial where they gave four grams of pure epa and they selected people who they thought would benefit the most from this intervention and those included people with diabetes high triglycerides because epa is known to lower triglycerides and they monitored them for cardiovascular events over a period of a few years and they found out that compared to their placebo arm those who were given four grams of epa per day did substantially better
but in randomized controlled trials a high dose of the omega-3 epa reduced triglycerides by 18 the downstream effect a 25 reduction in major cardiovascular events
but the very the most successful omega-3 trial in years was reduce it with four grams of epa and they they reported that the most the most striking the mo the only risk factor they could measure or thing in the blood that they measured that would predict outcomes it was better than cholesterol better than triglycerides was the omega-3 level was the omega-3 level achieved that was the strongest predictor of benefit in the reduced trial which makes perfect sense uh so they're starting to move that way so the reduce at trial yeah we can talk in a little bit let's get into the cardiovascular and um you know the the the reduce a try you said it was four grams of epa so they were using the vasepa and um is this is this the trial where there was like a 25 reduction in mortality cardiovascular related mortality cardiovascular events mortality right and was that was that correlated with the actual omega-3 index was that just the correlated that that that was the standard approach placebo versus active okay they saw that difference um did they do any sub-analysis with the omega-3 index well with omega-3 levels they yeah they yeah they measured omega-3 concentrations in the blood not percent comp but micrograms per ml there's another confusion here well yeah okay your epa is 10 micrograms per mil well how does that complain relate to the omega-3 we know how it relates but it's confusing for the medical world when you've got multiple metrics for omega-3 that have different units that being the case in in reduce it when they did look at their plasma epa concentrations at the end of the study people that had the highest biggest change in epa levels in the blood had the greatest benefits compared to those had minimal change and to your point about how in trial design if we want to go there again difference from drugs not only do you not when you do a drug trial you don't have the drug in the blood in the control group right and they and if it's experimental drugs they can't even go to the drugstore and get get it and cheat but with an omega-3 if you're assigned to placebo all you got to do is bite into one pill and you know you're on the placebo i mean during a five-year trial right it's it's going to be very clear that this is not fish oil and if you already believe that fish oil is good and you see that now you're going to be five years on a placebo in this trial you might want to go down to your local drugstore and pick off a bottle of fish oil and just take it and don't tell anybody or at the very least you can do your fish intake or start eating more fish right exactly but if you measure blood levels you'll find that person they're now in the treated group you know you don't measure blood levels you have no idea exactly so anyway nutrition research is tough but omega-3 is probably the easiest one of the easiest nutrients to study like a drug of all the nutrients because our background intake is so little and there's so little metabolism in vivo metabolism of omega-3 it's not controlled like calcium levels are controlled so tightly magnesium levels the blood are controlled tightly glucose is pretty tightly controlled yeah i mean but omega-3 is not very tightly controlled it's driven by diet how much do you eat um so it's it's the reason that omega-3 has been probably like the fifth most studied molecule in medicine uh is because it's been easy to study in in the drug model right plus it works so you said something that kind of piqued my interest about it you know not being tightly regulated because you know it's controlled by your diet is there like an upper upper uh like an upper level to the omega-3 index can you saturate that like if you think so nothing but fish yeah well or eat 25 grams a day right um which way in that study we don't know what the red cell was we didn't measure them we just did plasma but yeah in our experience at omega quantity we're looking at thousands of dried blood spot tests for omega-3 getting up above more than 15 16 so context right average americans roughly 5 omega-3 index which is epa and dha in red cells as a percent of the total fatty acids in the red cells so five percent of the fatty acids in the red cell membrane epa and dha japan it's on average nine percent eight nine ten percent because they eat so much more omega-3 than we do um vegans are down around three and a half percent as our u.s military personnel i'm
that being the case in in reduce it when they did look at their plasma epa concentrations at the end of the study people that had the highest biggest change in epa levels in the blood had the greatest benefits compared to those had minimal change
Um, we have all these randomized control trials. Now we have the reduced trial with vipa, high EPA showing 25% lower adverse cardiac events including stroke and heart attack compared to placebo.