Fish Oil

STRENGTH randomized 13,078 statin-treated high-risk adults to a 4 g/day EPA+DHA carboxylic-acid formulation or corn oil and was stopped early for futility after 1,384 of a planned 1,600 primary events. The composite cardiovascular endpoint did not differ significantly (12.0% vs 12.2%, hazard ratio 0.99, 95% CI 0.90-1.09, P=.84), and gastrointestinal adverse events were more frequent with the active formulation (24.7% vs 14.7%). Results from this EPA+DHA product versus corn oil should not be generalized to a different EPA-only prescription product or to all fish-oil supplements.^[1]

• Formulation, comparator (corn oil) and population differ from REDUCE-IT (icosapent ethyl vs mineral oil) and from typical retail fish oil.
• Abstract-checked; no qualified clinical review.

REDUCE-IT randomized 8,179 statin-treated high-risk adults to prescription icosapent ethyl (4 g/day) or a mineral-oil placebo, followed a median 4.9 years. The primary ischemic composite endpoint was lower with icosapent ethyl (17.2% vs 22.0%, hazard ratio 0.75, 95% CI 0.68-0.83, P<.001), but atrial fibrillation/flutter hospitalization was more frequent (3.1% vs 2.1%, P=.004) and serious bleeding was numerically higher but not statistically significant (2.7% vs 2.1%, P=.06). It does not establish the same benefit for ordinary EPA/DHA fish-oil supplements, and the mineral-oil comparator's inertness has itself been debated in linked commentary.^[2]

• Prescription EPA-only ethyl-ester formulation and selected high-risk population; comparator (mineral oil) differs from STRENGTH (corn oil) and from over-the-counter fish oil.
• Abstract-checked; no qualified clinical review.