Effects of Omega-3 Supplementation on Serum

Triglyceride Levels in Adults with

Hypertriglyceridemia: A Systematic Review

Monica Moore RD, LD

APN 760

[email protected]
 ABSTRACT

Objective: To evaluate the effects of oral omega-3 fatty acid supplementation on serum

triglyceride levels in adults with hypertriglyceridemia.

Methods: A systematic literature review of randomized, placebo-controlled, double-blind trials

between 2014-2019 concerning triglyceride reduction from omega-3 supplementation. PubMed,

BioMed Central, and CINAHL Complete databases were used to examine 130 articles, nine of

which met inclusion criteria and four discussed in this review.1,2,3,4

Results: All studies included a control group. Reductions in serum triglycerides were seen in all

four studies reviewed, as well as increase in omega-3 index. Between 14.2-32.1% reductions in

triglycerides seen with supplementation in as little as eight weeks with 2-4 grams of omega-3.

Conclusions and Implications: Between 2-4 grams daily of oral omega-3 supplementation in

various formulations has been shown in recent research to lower serum triglycerides in adults

with an average age of 40-70 with hypertriglyceridemia. Statistically significant reductions were

seen in treatment groups in all four studies compared to placebos. Greater improvements were

seen in serum triglycerides in those with higher levels at baseline. Effects of supplementation in

a smaller age range and among ethnically diverse populations should be investigated, as well as

further narrowing of recommended dosing and time frames for peak improvement.

Keywords: hypertriglyceridemia (MeSH), omega 3 fatty acids (MeSH), fish oils (MeSH)
 2

INTRODUCTION

Triglycerides are a type of fat in the blood that are stored in fat cells. Between meals,

they can be released for energy.4 However, too many of these can be linked to health risks such

as coronary heart disease, insulin resistance, acute pancreatitis, and reduction of HDL

cholesterol.4 Elevated levels are considered those over 150 mg/dL.5 Severe hypertriglyceridemia

is considered levels over 500 mg/dL.3,4 Typical recommendations for improvement of high

triglycerides includes weight loss, increased exercise, reduced simple carbohydrate intake,

cholesterol lowering medications, and cessation or reduction of alcohol.2,4 Recently, more

research has arisen about the potential triglyceride-lowering effects of omega-3 fatty acids, both

in food and supplementation.1,2,3,4

Omega-3 fatty acids are polyunsaturated free fatty acids typically from fish oils.1 They

act to reduce the number of transporting lipoproteins available in the bloodstream.1 The most

common types are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).1 Common

food sources of omega-3 fatty acids include fish, seafood, nuts, seeds, flaxseed oil, soybean oil,

and canola oil.6 In supplement forms, there are many different formulations available.4

Recent research suggests that due to their role in transporting lipoproteins,

supplementation of omega-3 may lower triglyceride levels in the blood. Objectives of this review

are to examine these effects of omega-3 fatty acid supplementation of varying formulations on

serum triglyceride levels in adults already with high triglycerides. The age group of interest was

adults age 40-70 years old with triglycerides over 150 mg/dL of any ethnicity but without

diabetes. Four studies that met inclusion criteria were reviewed.

 3

PICO(t) Question: In adults age 40-70 years old with hypertriglyceridemia, what is the effect of

2-4 grams of oral omega-3 fatty acid supplementation over 8 weeks or more on lowering serum

triglyceride levels.

METHODS

The systematic review was performed solely by the author, a Registered Dietitian.

Inclusion criteria for the review are shown in Table 1. Inclusion criteria included age 40-70 years

old, all races and genders, living outside of a facility or hospital, hypertriglyceridemia, and non-

diabetic. Study design preferences included randomized controlled trials and studies with groups

larger than ten individuals per each group of the study. The range of publication years was 2014-

2019 to assess just the last five years. English was the language chosen for articles.

Exclusion criteria (shown in Table 2) were ages younger than 40 or older than 70,

hospitalized or facility-living individuals, diabetes, and systematic reviews or meta-analyses.

Study groups with less than ten individuals excluded studies from being part of the review, as

well as articles not written in English or published earlier than 2014.

Search databases used included PubMed, BioMed Central, and CINAHL Complete. No

other search engines were used. MeSH keywords searched included “hypertriglyceridemia”,

“omega 3 fatty acids”, and “fish oils”. A PRISMA 2009 Flow Diagram (Figure 1) shows how

419 articles were identified through the database search, resulting in 130 articles to screen after

duplicates were removed. 91 of these articles were excluded based on titles and abstracts due to

using animal subjects, using supplements versus foods instead of a placebo, participants having

diabetes, or being review articles. Of the remaining 39 full-text articles that were assessed for

eligibility, 30 were excluded for similar reasons as previously stated or having too small sample
 4

size or not assessing serum triglycerides as an outcome. Nine articles were remaining by the end

of the eligibility screening and four were chosen to evaluate for this systematic review. All four

examined an omega-3 supplement versus a placebo and measured serum triglycerides as the

main outcome measure. The difference between baseline and end of study for each group and the

difference in means between the intervention and placebo group at end of study for each trial was

reviewed.

Quality grades were assigned to the four articles reviewed based on the Academy of

Nutrition and Dietetics Evidence Analysis Library (EAL) Quality Criteria Checklist and grading

guidelines for primary research.7 All four articles were classified as Class A and three had

quality ratings of good and one was neutral. This assessed bias and risk for bias as well in the

quality rating. While no significant bias was identified in three studies, potential for bias was

observed. This will be discussed further in the discussion section. All four articles were

randomized, placebo-controlled, double-blind trials. Data was extracted from the studies

independently from the studies by the sole researcher.

RESULTS

In the 2018 study by Stroes et al, the researchers used a randomized, double-blind,

placebo-controlled, parallel-group study to analyze the effects and safety of 2 grams of omega-3

oral supplements daily compared to an olive oil placebo pill in reducing serum triglyceride levels

and other lipid values in participants with hypertriglyceridemia.1 162 adults of both genders were

studied over 12 weeks with a mean age of 49-50 years old.1 Participants had

hypertriglyceridemia with starting labs between 500-2500 mg/dL.1 81 participants were

randomized into each group.1 Significant reductions were seen in triglycerides in the treatment
 5

group compared to placebo group by 14% by the end of the study.1 Additionally, while not

statistically significant, more dramatic improvements were seen in triglycerides by 23% in those

with baseline triglycerides over 885 mg/dL.1 The results of this study were consistent with

previous studies supporting the safety and efficacy of omega-3 supplementation with minimal

side effects.1 Limitations of the study include all patients sampled being Caucasian without other

ethnic groups represented, patients stopped lipid-lowering medications prior to the study so no

additional assistance was being provided in triglyceride lowering that may typically be in a non-

study setting, and there are unknown effects of olive oil (used for the placebo) on triglyceride

levels.1 Applying the data and methods of this article to the EAL Quality Criteria Checklist, this

article received a positive (+) quality rating.

In a 2015 study by Hendengran et al, researchers used a prospective, randomized, double-

blind, placebo-controlled, parallel, three-arm interventional trial to investigate the effects of

long-chain omega-3 fatty acids on non-fasting triacylglycerol levels.2 120 adults of both genders

with a mean age of 60-64 years old participated.2 Participants had hypertriglyceridemia with

starting fasting triglycerides between 150-500 mg/dL.2 Two intervention groups provided either

two re-esterified n-3 PUFA capsules twice daily (n=39) or two 1000mg EE-PUFA capsules

twice daily for 8 weeks (n=40).2 Both of these groups were compared to a placebo group (n=40)

receiving two olive oil capsules twice daily.2 Results showed a significant decrease in fasting

triacylglycerols by 28% in the AG n-3 PUFA group, 22% in the EE-PUFA group, and no

significant change in the placebo group.2 The omega-3 index increased by 63% in the re-

esterified n-3 PUFA group and 59% in the EE-PUFA group, which were both statistically

significant (p<0.0001).2 This study was first to examine effects of long-chain n-3 PUFA on

fasting triacylglycerols and thus more research is needed.2 Limitations of the study included the
 6

analyzation of samples, which occurred continuously and individually over nine months and

possibly altered resulting assays compared to being analyzed as a group.2 Additionally, the study

itself only lasted 8 weeks and is unable to lend results to possible long-term effects of

supplementation.2 Applying the data and methods of this article to the EAL Quality Criteria Checklist,

this article received a positive (+) quality rating.

In the 2017 study by Mosca et al, a randomized, double-blind, placebo-controlled trial

was used to analyze the effects of icosapent ethyl (omega-3 fatty acid) on triglyceride levels

versus a placebo.3 215 adult women with a mean age of 58-63 years old were included with

hypertriglyceridemia and starting values between 200-2000 mg/dL.3 These women were also

enrolled in the MARINE or ANCHOR studies.3 The treatment group consisted of 109

participants receiving 4 grams daily of oral icosapent ethyl omega-3 supplement over 12 weeks.3

The placebo group had 106 participants and were given oral placebo pills daily over 12 weeks.3

Results showed significant average percent reduction in triglycerides with supplementation of

icosapent ethyl from baseline to the end of the study compared to placebo by 23% in women,

which was statistically significant (p<0.0001).3 Furthermore, decreases were seen in other lipid

levels, such as non-HDL cholesterol and total cholesterol.3 This study adds to current research by

filling a gap for the effects of omega-3 supplements on lowering lipid levels in women

specifically.3 A limitation of the study was a smaller sample size than stated due to pooling of

data from the two data collection populations of the MARINE and ANCHOR studies.3 Applying

the data and methods of this article to the EAL Quality Criteria Checklist, this article received a neutral

() quality rating.

In the 2017 randomized, double-blind, placebo-controlled study by Su et al, the effects of

2 grams or 4 grams daily of Omacor were studied in participants with hypertriglyceridemia.4

Omacor contains ethyls-ester omega-3 fatty acids developed by Pharmatech Labs.4 253
 7

participants with a mean age of 54 years old and starting fasting serum triglycerides between

200-1000 mg/dL were randomized into one of two treatment groups or a placebo group.4 The

groups included 1gram oral Omacor supplement twice daily for 8 weeks (n=77), 2 grams oral

Omacor supplement twice daily for 8 weeks (n=65), and placebo group receiving an olive oil pill

twice daily for 8 weeks (n=68), all after a 5-week leading period.4 Participants were asked to

follow a low fat diet and meet monthly with a dietitian to assess compliance.4 Statistically

significant reductions in triglycerides were seen between Omacor groups compared to the

placebo.4 A 30% and 32% reduction in triglycerides were seen in the 2 gram and 4 gram daily

Omacor groups, respectively.4 Unfortunately, LDL-C was increased between treatment and

placebo groups by 6-7% by week four (p=0.0096, p=0.0036). Further studies are needed to

investigate this.4 This study is in agreement with previous studies showing triglyceride-lowering

effects of omega-3.4 Limitations included a population of all Asian and strict diet that may not be

realistic in non-study environment and may be a confounding variable that affects triglycerides.4

Applying the data and methods of this article to the EAL Quality Criteria Checklist, this article received a

positive (+) quality rating.

DISCUSSION

This systematic review of current literature on the topic of omega-3 fatty acid

supplementation and hypertriglyceridemia supported other previous research and reviews about

the same. It adds to the already supported idea. There were many strengths of this review and the

studies included, however there were also limitations and the risk of bias in some.

Strengths of the studies include large sample sizes, varied supplement formulations,

design, age, and exclusions. The large sample sizes of the studies allowed for results to be seen

and potential for negative results to be included if there were any. Studies used varied forms of
 8

omega-3 fatty acid supplementation but in similar doses to be able to compare them still and see

that all forms used showed similar results and thus improvements in triglycerides were not

limited to one type. All four studies were randomized, placebo-controlled, double-blind trials,

which is considered the gold-standard for research study design. The mean ages of the studies

were similar, allowing for ease of comparison between the results of the different studies. And

finally, diabetes as an exclusion limited the potential confounding factor, as diabetes control or

lack thereof can alter triglyceride levels and thus could skew results when looking to isolate

supplementation of omega-3 effects.

Limitations or weaknesses include lack of ethnic diversity and study time frames. Su et al

and Stroes et al studies had homogenous populations, examining only Asian and Caucasians,

respectively.1,4 Looking at only one population prevented seeing the effects of omega-3 on

triglycerides in varying ethnic groups or if results varied with different ethnicities. Study time

frames were relatively short (8-12 weeks) and despite still seeing positive results in that time,

longer studies could have solidified these results further and potentially seen continued

improvement or plateaus and when they would occur.

Additional methodology limitations included medication and dietary changes required for

participation. In the Stroes et al study, participants stopped any lipid-lowering medications prior

to the study period to not be a confounding variable affecting triglyceride levels.1 However, this

could have made triglycerides higher to start and unrealistic for modern medical practice to

expect a patient with extremely high triglycerides or cholesterol levels to not be recommended to

take medication for it. Additionally comes the ethical discussion of stopping a medication that is

helping improve their health condition in order to participate in a study and see if omega-3 fatty

acid supplements will help in the proven prescription medication’s place.

 9

Diet changes have already been shown to be an effective intervention at lowering

triglyceride levels, specifically a low fat, lower carbohydrate diet.5 Su et al had the participants in

all of their study groups, including the placebo group, follow a low fat diet for the duration of the

study.4 This could have lowered triglyceride levels further in each group from diet change,

exacerbating the results of the triglyceride-lowering effects of the treatment groups or

minimizing the significance or difference between groups when compared.

Potential for bias include the participation of pharmaceutical companies in the studies for

funding and the providing of the supplements/placebos for the intervention. In Su et al, Excelsior

Pharmatech Labs in Taiwan funded the study and also produced and provided Omacor

supplements for the research.4 Similarly, Stroes et al was funded by a pharmaceutical company

called AstraZeneca.1 While they did not produce the omega-3 supplements used in the trial, they

do produce a product called EPANOVA that is an omega-3 carboxylic acid approved by the US

FDA in 2014 and is marketed to lower severe hypertriglyceridemia.8 Amarin Pharma Inc, funded

the Mosca et al study.3 This presents a potential bias that three of the four studies were funded by

pharmaceutical products that produce and sell the products tested in the research or similar

products and would financially benefit from the studies succeeding in proving

hypertriglyceridemia was improved by omega-3 supplements.

Results seen in this systematic review is consistent with other systematic reviews and

accepted recommendations over recent years.9,10 A 2014 review similarly showed that omega-3

fatty acid supplements have been shown to be a good alternate intervention option for the

prevention of cardiovascular disease, which can be promoted by high triglycerides.10 The

American Heart Association (AHA) released an advisory about using 4 grams of omega-3 fatty

acids daily in the management of hypertriglyceridemia being a safe and effective option.9 This is
 10

recommended by the AHA as either a sole therapy option or in combination with other lipid-

lowering interventions.9

CONCLUSION

Between 2-4 grams daily of oral omega-3 supplementation in various formulations has

been shown in recent research to lower serum triglyceride levels in adults participants with an

average age of 40-70 years old with hypertriglyceridemia. In all four studies reviewed,

statistically significant differences were seen in supplementation groups compared to placebo

groups, no matter the omega-3 dosage used, with between 14.2-32.1% reductions in

triglycerides. Greater improvements were seen in serum triglycerides in those that started with

higher triglyceride levels at baseline.

Grade Assigned: Grade I: Good per Evidence Analysis Library (EAL) grading guidelines.7

IMPLICATIONS FOR RESEARCH AND PRACTICE

While a lot of research on this topic has already occurred and some has been summarized

in this review, there are some implications for future research to further the knowledge on the

omega-3 and triglyceride relationship. Further narrowing down doses of omega-3 fatty acid

supplementation to be effectively used for triglyceride-lowering would be beneficial. The range

discussed in this review was between 2-4 grams per day. While results were seen, it would be

interesting to see a lower and higher dose to see where results begin to be seen with

supplementation and where results plateau with higher doses. This could also give a maximum

dose for effectiveness but safety. Another area for future research is within different ethnic

groups. One of the studies reviewed examined solely Caucasians while another examined solely
 11

Asians. This is a good starting point but there are many groups not yet examined in an isolated

study to see if certain populations see more impressive or less improvements in triglycerides with

omega-3 fatty acid supplementation. Additionally, a more condensed age range could be

explored to see if there are differences or significance of results.

With the results of this systematic review and current research on the effects of omega-3

fatty acid supplementation and triglycerides, 2-4 grams of omega-3 fatty acid supplementation

daily can be recommended in most adults to aid in the reduction of triglycerides by health care

professionals with reservations. A consideration may be if a person is on anticoagulants, as the

effects of omega-3 on bleeding risk is still being investigated.11,12 In this case, risk versus benefits

discussion should occur between a patient and physician. Another consideration would be if

someone was experiencing gastrointestinal upset from using these supplements.13

Since omega-3 fatty acid supplementation has shown improvements in triglyceride levels

in as little as 8-12 weeks per the studies reviewed, health care providers have a better timeline for

expected improvements. In some studies reviewed, some results, even if not peak results, were

already being measured by week two of the study.4 This could guide when labs are rechecked

and when trial periods of supplementation can be used before implementation of more aggressive

prescription lipid-lowering medications.

Interestingly, a 2016 randomized controlled trial exploring continuing education for

physicians on treatment of hypertriglyceridemia, which included omega-3 fatty acids, showed

some knowledge gaps.14 This study used online educational interventions about

hypertriglyceridemia treatment and found based on pre- and post tests that of the 917 physicians

that participated, 57% remained unaware of the potential effects of omega-3 fatty acids.14 This
 12

study, along with the results of this systematic review, supports the need for continued research

and education for use in practice of the omega-3 and triglyceride association.

FUNDING

There was no funding, potential biases, or significant business relationships to disclose

for this systematic review.

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REFERENCES

1. Stroes ESG, Susekov AV, de Bruin TWA, Kvarnstrom M, Yang H, Davidson MH. Omega-3

carboxylic acids in patients with severe hypertriglyceridemia: EVOLVE II, a randomized,

placebo-controlled trial. J Clin Lipidol. 2018; 12(2): 321-330.

2. Hedengran A, Szecsi P, Dyerberg J, Harris W, Stender S. n-3 PUFA esterified to glycerol or

as ethyl esters reduce non-fasting plasma triacylglycerol in subjects with hypertriglyceridemia:

A randomized trial. Lipids. 2015; 50(2): 165-175.

3. Mosca L, Ballantyne C, Bays H, et al. Usefulness of icosapent ethyl (eicosapentaenoic acid

ethyl ester) in women to lower triglyceride levels (results from the MARINE and ANCHOR

trials). Preventative Cardiology. 2017; 119(3): 397-403.

4. Su TC, Hwang JJ, Huang KC, et al. A randomized, double-blind, placebo-controlled clinical

trial to assess the efficacy and safety of ethyl-ester omega-3 fatty acid in Taiwanese

hypertriglyceridemia patients. J Atheroscler Thromb. 2017; 24(3): 275-289.

5. Triglycerides: Why do they matter? Mayo Clinic Web site. https://mayoclinic/org/diseases-

conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186. Updated 2019.

Accessed November 30, 2019.

6. Omega-3 Fatty Acids. National Institutes of Health Web site.

https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/. Updated July 11, 2019.

Accessed November 30, 2019.

7. Evidence Analysis Manual: Steps in the Academy Evidence Analysis Process. Academy of

Nutrition and Dietetics Web site.

www.andeal.org/vault/2440/web/files/EAL/2016_April_EA_Manual.pdf. Updated April 2016.

Accessed November 23, 2019.

 14

8. AstraZenena Web site. https://www.astrazeneca.com/search-results.s.html?q=omega+3.

Updated May 6, 2014. Accessed December 7, 2019.

9. Skulas-Ray A, Wilson P, Harris W. Omega-3 fatty acids for the management of

hypertriglyceridemia: A science advisory from the American Heart Association. Circulation.

2019; 140: e673-e691.

10. Arca M, Borghi C, Pontremoli R. Hypertriglyceridemia and omega-3 fatty acids: Their often

overlooked role in cardiovascular disease prevention. Nutr Metab Cardiovasc Dis. 2018; 28(3):

197-205.

11. Apsite K, Pukite K, Tupahins A, et al. Potential drug interactions with oral anticoagulants

among atrial fibrillation patients. EP Europace. 2018; 20(1): i70.

12. Hamazaki T, Colleran H, Hamazaki K, Matsouka Y, Itomura M, Hibbeln J. The safety of fish

oils for those whose risk of injury is high. Military Medicine. 2014; 179(11): 134-137.

13. Omega-3 Supplements in Depth. National Center for Complimentary and Integrative Health

Web site. https://nccih.nih.gov/health/omega3/introduction.htm. Updated May 2018. Accessed

December 5, 2019.

14. Larkin A, LaCouture M, Boutsalis G, Bays H. Impact of continuing medical education on the

treatment of hypertriglyceridemia with omega-3 fatty acids. Circulation. 2016; 9(2): A168.
 15

Table 1. Inclusion

criteria
 16

Table 2. Exclusion criteria

 17

Figure 1. PRISMA 2009 Flow Diagram

 18

Table 3. Summary of Findings

Quali Conclusions/
Author, Year, Study Purpose –
ty Results – Should
Should be a single
Grad Study Population Intervention and be a single
Study Design, objective Outcome Data
e (Demographics) Setting conclusion
Country, Funding statement in one
(+, -, statement in one
Source to two sentences.
Ø) to two sentences.

Stroes ESG, + To study the • 162 adults, both Treatment Group: Significant 2g per day of oral
Susekov AV, efficacy and safety genders 2g daily of omega- reduction in omega-3
Bruin TWA, of 2gm omega 3 • over 18 years 3 fatty acid triglycerides by supplementation
Kvamstrom M, daily compared to old supplementation 14.2% in improved
Yang H, placebo in • BMI of at least (n = 81) treatment group triglyceride levels
Davidson MH. reducing serum 20 kg/m2 compared to olive from baseline after
2018 triglycerides and • hyperlipidemia Placebo Group: 2g oil group from 12 weeks
lipid levels in with triglycerides daily of olive oil baseline to end of significantly more
Study Design: patients with at least 500 daily (n = 81) study. than in placebo
Randomized, hypertriglyceridem mg/dL but under group.
double-blind, ia. 2500 mg/dL Setting: More dramatic
placebo- participant’s home improvement in
controlled, (Exclusions: triglycerides
parallel-group known allergy to (22.7%) in
trial omega 3, participants with
prescription meds baseline
Country: UK containing EPA triglycerides >885
and DHA, recent mg/dL, although
pancreatitis, not statistically
Funding:
uncontrolled DM) significant.
AstraZenica

Hendengran A, + To investigate the • 120 adults, both Treatment Group Non-fasting Both types of
Szecsi P, effect of long- genders 1: 2 capsules BID plasma omega-3 fatty acid
Dyerberg J, chain omega-3 • over 18 years with meals for 8 triacylglycerols supplementation
Harris W, fatty acids on non- old weeks of re- decreased improved/lowered
Stender S. 2015 fasting • fasting esterified n-3 significantly by non-fasting
triacylglycerol triglycerides PUFA (n = 39) 28% in re- triglyceride levels
Study Design: levels.      between 150-500 esterified AG n-3 in adults after 8
prospective, mg/dL Treatment Group PUFA group, 22% weeks.
randomized, 2: 2 capsules BID in EE-PUFA
double-blind, with meals for 8 group, and no
placebo- (Exclusions: weeks of 4000mg significant change
controlled, history EE-PUFA (n = 40) in placebo.
parallel, three- pancreatitis,
arm gallstone disease, Placebo Group: 2 Omega-3 index
interventional cancer treatment capsules BID with increased by
trial in past 2 years, meals for 8 weeks 63.2% in re-
uncontrolled of 4600mg olive oil esterified n-3
Country: diabetes, (n = 40) PUFA group and
Denmark hypertension, 58.5% in EE-
hypothyroidism, PUFA group
nephrotic Setting:
Funding: Marine Copenhagen (p<0.0001).
 19

Ingredients, syndrome, use of University

Department of steroids) Heart rate
Clinical decreased by 3
Biochemistry at beats per minute
Copenhagen in AG-PUFA
University group.
Hospital

Mosca L, Ø To analyze the • 215 adult Treatment Group: Significant 4 g/day of

Ballantyne C, effects of women 4 g/day of oral average percent icosapent ethyl
Bays H, et al. icosapent ethyl • triglycerides icosapent ethyl reduction in supplementation
2017 (omega-3 fatty 200-2000 mg/dL omega-3 triglycerides with can significantly
acid) on • controlled on supplement x 12 icosapent ethyl reduce triglyceride
Study Design: triglyceride levels statin weeks (n = 109) from baseline to levels in adults
Placebo- and other • enrolled in end of study with
controlled, inflammatory MARINE or Placebo Group: compared to a hypertriglyceridemi
randomized, parameters versus ANCHOR study oral placebo pill placebo by 22.7% a.
double-blind a placebo.     daily x 12 weeks (p=0.0327), 21.5%
(Exclusions: Not (n = 106) (p<0.0001) in
Country: United discussed) women.
States Setting:
Participant’s Decreases seen in
Funding: Amarin homes other lipid levels,
Pharma, Inc. including
reductions in non-
HDL cholesterol
and total
cholesterol.

Significant
increases in red
blood cells and
plasma noted in
those receiving
intervention
compared to
placebo from start
to end of study
(p<0.0001). 
 20

Su TC, Hwang + To study the • 253 adults Treatment Group Statistically The primary
JJ, Huang KC, et effects of 2 g/day • ages 20-79 1: 1gm oral significant hypothesis was
al. 2017 and 4 g/day years old Omacor reductions in confirmed with
Omacor (ethyle- • fasting serum supplement BID x triglycerides seen significant
Study Design: ester omega-3 triglycerides 8 weeks after 5 between Omacor improvements in
Randomized, fatty acids) on between 200- week leading supplements triglyceride levels
double-blind, patients with 1000 mg/dL at period; low fat diet compared to with both dosages
placebo- hypertriglyceridem screen (n = 77) (+2 placebo. A 32.1% of Omacor omega-
controlled, ia.   • discontinuing withdrawals) reduction and 3 supplements
parallel trial other lipid- 29.7% reduction in versus a
altering meds Treatment Group triglycerides were placebo.    
Country: Taiwan 2: 2gm oral seen with 4g/day
(Exclusions: LDL- Omacor and 2g/day
Funding: C levels above supplement BID x Omacor,
Excelsior treatment goal, 8 weeks after 5 respectively, by
Pharmatech taking meds with week leading week 8.
Labs omega-3 or red period; low fat diet
yeast rice, high (n = 65) (+ 4 LDL-C levels
consumption of withdrawals) statistically
fatty fish, severe significantly
diseases, Placebo Group: different between
uncontrolled olive oil oral Omacor and
diabetes, history placebo pill BID x placebo groups.
of alcoholism, 8 weeks after 5 7.2% (p=0.0036)
hypolipidemia) week leading improvement from
period; low fat diet baseline to week 4
(n = 68) (+4 in Omacor 2g/day
withdrawals) group and 6.3%
(p=0.0096)
improvement in
Biweekly visits 4g/day group. This
and one monthly change sustained
visit to check lab from week 4 to
work; Monthly RD
week 8.    
visits for diet
compliance

Setting: Patient’s
home, lab, RD
office, hospital