Interaction between omega-3 fatty acids and statins for heart health examined in the review

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A new review1 published in the journal Nutrients looked at whether the combination of omega-3 polyunsaturated fatty acids and a statin drug had a positive or negative interaction on cardiovascular health. While both statins and omega-3 polyunsaturated fats have heart health benefits, including lowering LDL cholesterol and triglycerides, respectively, the effects of taking statins and omega-3s at the same time are not well understood. Ultimately, the review found that the combination of omega-3s and statins can sometimes be complementary, but also antagonistic, for heart health. The authors note that further intervention studies are needed to investigate the interaction.

Statins, classified as antidyslipidemic drugs, have been shown to potentially reduce cardiovascular disease and mortality rates by lowering LDL cholesterol. Dyslipidemia is an abnormal amount of lipids, including triglycerides, cholesterol, and fatty phospholipids, in the blood.

Meanwhile, omega-3 polyunsaturated fatty acids may help reduce triglycerides, although the authors note that “the mechanisms of action are not fully understood; However, it is believed that a combination of reduced triglyceride synthesis and increased oxidation of triglycerides by [omega-3 long-chain polyunsaturated fatty acids] act to lower circulating triglyceride levels. “

The authors also point out that omega-3s and statins share some overlapping similarities. These include their ability to improve endothelial nitric oxide synthesis, inhibit the production of pro-inflammatory cytokines, and lower LDL cholesterol by increasing active and mRNA expression of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase ( HMG-CoA.) Suppressed) enzyme. Therefore, in this review, the authors tried to investigate the complementary or competing effects of the combined use of statins and omega-3 fatty acids.

The authors cite clinical studies that investigated the effect of various statins with long-chain polyunsaturated omega-3 fatty acids on cardiovascular risk factors in patients with elevated cholesterol and triglyceride levels. In these studies, the combination of omega-3 fatty acids and statins reduced triglycerides, total cholesterol, and the thrombotic potential of patients compared to statins alone. The authors concluded that concomitant therapy with statin drugs and omega-3 polyunsaturated fatty acids is generally complementary. In addition to the potential of the combination for lowering triglycerides and LDL cholesterol, it can also lower the particle size of LDL cholesterol, resulting in a more favorable lipoprotein distribution.

On the other hand, the available data also indicate that the simultaneous use of statins and omega-3 fatty acids can have antagonistic effects. First, statins and omega-3 fatty acids interact to modulate fatty acid synthesis and metabolism. “Pleiotropic effects of statins and [omega-3 long-chain polyunsaturated fatty acids] overlap ”, write the authors. “For example, cytochrome P450 enzymes that metabolize statins can affect the metabolism of long-chain, polyunsaturated omega-3 fatty acids, and vice versa.” Statins can also alter the balance of omega-3 and omega-6 fatty acids, which Increase the inflammatory eicosanoids and contribute to arteriosclerosis.

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In addition, statins can cause mitochondrial ubiquinone deficiency, which blocks the ability of omega-3 fatty acids to precondition myocytes or muscle cells. This reduces their effectiveness in reducing irregular heartbeat.

Finally, while both statins and omega-3 fatty acids block HMG-CoA reductase, omega-3 fatty acids block HMG-CoA reductase, albeit less effectively, which leads to a lower effect size of the combination.

Both omega-3 polyunsaturated fatty acids and statins are recommended for the prevention of cardiovascular disease, the authors conclude, although each nutrient has its own mode of action. And although the characteristics of the cardiovascular health effects of omega-3s and statins overlap, “prospective intervention studies stratifying for statin use are warranted to further investigate the interaction.”

Also read:

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American Heart Association recommends omega-3 supplements for secondary prevention of coronary artery disease

Industry associations respond to meta-analysis of omega-3 and heart disease research

References:

1. Bird JK et al., “The Role of N-3 Long Chain Polyunsaturated Fatty Acids in Prevention of Cardiovascular Disease and Interactions with Statins,” Nutrients. vol. 10, no. 6 (June 15, 2018): 775

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