Don't Be Too Quick to Jump on the Vascepa (Icosapent Ethyl) Bandwagon

You'll hear cautious optimism about cardiovascular benefits with the Rx omega-3 fatty acid, Vascepa (icosapent ethyl)...and see a flood of ads.

Vascepa is a form of EPA (eicosapentaenoic acid). Other Rx omega-3s (Lovaza) or fish oil supplements have EPA and DHA (docosahexaenoic acid).

New evidence suggests Vascepa 2 g BID may prevent a CV event in about one in 21 high-CV-risk patients over 5 years compared to placebo. This is in patients with elevated triglycerides of about 215 mg/dL despite statins...and CV disease OR diabetes plus other CV risks (high BP, etc).

But prior studies with LOWER omega-3 doses of about 1 g/day are conflicting...or suggest only slight benefit in some CV patients.

Don't be too quick to jump on the Vascepa bandwagon. Point out that researchers are scratching their heads about this new evidence.

Vascepa only modestly lowers triglycerides...so this doesn't explain its CV benefit. And there's still no proof that using fish oil, fibrates, or niacin specifically to lower triglycerides improves CV outcomes.

Some question whether Vascepa's results are inflated...since the study's mineral oil placebo may reduce statin absorption.

Plus Vascepa seems to lead to atrial fib in about one in 71 patients. It might also increase bleeding...and costs about $275/month.

Save Vascepa for patients with elevated triglycerides and CV disease or diabetes plus other CV risks...AFTER a statin and lifestyle changes.

Don't extrapolate Vascepa's benefits to other omega-3s. Stay tuned for a study in a year or so to help define their role. For now, point out it's not practical to get this high EPA dose from Lovaza or supplements.

If lower-CV-risk patients want to use fish oil, explain it's okay to try about 1 g/day of USP Verified omega-3s...but CV benefit isn't likely.

Emphasize other measures to decrease CV risk, such as a healthy diet with at least two 3.5 oz servings/week of fatty fish (salmon, tuna, etc).

See our chart, Omega-3s: Fish Oil and More, for guidance. Use our patient handout, Fish Oil and Other Omega-3s, to clarify the options.

• FAQ: Omega-3s: Fish Oil and More
• Chart: Non-Statin Lipid-Lowering Agents
• Patient Education: Fish Oil and Other Omega-3 Fatty Acids