Fish oils can be added to a statin or other LDL-lowering regimen to reduce triglycerides (and therefore non-HDL). The triglyceride-lowering effect of fish oils appears to result from the combined effects of inhibition of lipogenesis and stimulation of fatty acid oxidation in liver. They inhibit the transcription of genes coding for lipogenesis enzymes and increase the transcription of the regulatory enzymes of fatty acid oxidation. Fish oils inhibit VLDL synthesis and improve clearance of remnant particles. Alone, fish oils lower triglycerides by 30-40% but have little effect on HDL and have no effect on LDL.
When combined with a statin, they add to the triglyceride lowering but may blunt the LDL lowering. Fish oil products that contain a high concentration of omega-3 fatty acids (docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA]) should be selected, as this appears important to CHD risk reduction. Omega-3 fatty acids have other effects that may be advantageous in lipid patients, including reductions in fibrinogen levels, blood pressure, and cell proliferation and a potential protective effect against sudden death due to ventricular dysrrhythmias. Doses of the omega-3 fatty acids should be 1-2 g daily, which generally requires the administration of 2-12 grams of fish oil daily.
Common adverse effects of fish oils are:
The most effective substance in fish oils is: