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Which is better: fish oil or Vazkepa?

Founder of London Medical, Dr Ralph Abraham shares his thoughts on omega 3 fatty acids, the choices available and why they matter.

Many people buy fish oil capsules enthused by the idea that they will be protected from heart disease and by stories that it is good brain food that will keep mentation at elevated levels for longer. The active ingredients are omega 3 fatty acids, and they are not all the same; with the cheaper fish oils being unpurified and somewhat fishy in the odour they leave behind, while purified eicosapentaenoic and docosahexaenoic acid formulations make these food supplements very expensive.

Doctors dealing with cholesterol problems use omega 3 fatty acids to lower triglyceride which can be life threatening in some patients where they are exposed to the risk of severe pancreatitis. However, after negative clinical trials, they were not recommended purely as a protection against heart disease.

But all omega 3 fatty acids are not the same. Recently, Vazkepa or icosapent ethyl, which is a highly purified omega 3 fatty acid preparation, has been shown to be very useful to people at risk of heart attack and in people with raised triglyceride. So much so that The National Institute for Health Care Excellence (NICE) has deemed it something that the NHS should reimburse in restricted cases.

Vazkepa is the first licensed treatment shown to reduce the risk of cardiovascular events (heart attacks and strokes) in people with treated LDL cholesterol taking a statin who also have a raised triglyceride. This type of lipid abnormality is often called a dyslipidaemia. Typically, there is a catch: NICE only recommends funding for those individuals with increased triglycerides who already have established high risk already on statins.

A more logical approach, if private funding is available, is to make the drug available to all patients at known increased risk for premature cardiovascular disease, who also have a raised triglyceride. 

At London Medical, we believe that if regular omega 3 fatty acids are needed to be prescribed to lower the triglyceride, then why not substitute these for icosapentyl ethyl as this has been shown to improve the risk of cardiovascular events? The use of other agents or LDL targets should not limit its use.

I would prescribe it to those with high triglyceride, at known risk of future cardiovascular events (stroke and / or heart attack) irrespective of the LDL cholesterol they achieve. In our practice, this is usually determined  by how advanced their atherosclerosis is and their current risk profile.

July 2022

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