Amarin Corp Plc (AMRN)

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New from Saudi Arabia authors
Taher Z A, Taher A A, Radi S (March 16, 2024) An Update on Dyslipidemia Management and Medications: A Review. Cureus 16(3): e56255. doi:10.7759/cureus.56255

https://www.cureus.com/articles/225432-an-update-on-dyslipidemia-management-and-medications-a-review

https://assets.cureus.com/uploads/review_article/pdf/225432/20240316-1782-zyexoy.pdf

Omega-3 Fatty Acids (FAs)

“Similar to fibrates, omega-3 FAs primarily impact triglycerides, reducing levels by 25%-30%. They are approved by the American Heart Association for use in hypertriglyceridemia. However, certain forms of omega-3 FAs may increase LDL-C levels. Despite extensive clinical trials, Omega-3 FAs have failed to demonstrate a mortality benefit in cardiovascular patients. Trials like ASCEND and STRENGTH, involving large sample sizes, did not show cardiovascular benefits [23,24]. The STRENGTH trial was terminated early due to the absence of cardiovascular benefits and common gastrointestinal side effects in the active treatment group. Unfortunately, the exact mechanism of action for Omega-3 FAs in triglyceride reduction is not well understood [25].

“It's intriguing that despite the association between hypertriglyceridemia and increased ASCVD events, omega-3 FAs and other triglyceride-lowering agents like fenofibrate have not demonstrated a decrease in ASCVD morbidity or mortality. As a result, their approval is limited to cases of severe hypertriglyceridemia (>500-1000) to prevent pancreatitis.

“The controversy surrounding this may be attributed to the possibility that omega-3 FAs were used in less effective doses or the use of different forms, such as eicosapentaenoic acid (EPA) and/or docosahexaenoic acid. This highlights the importance of understanding the nuances in dosages and specific formulations when studying the effectiveness of these agents in preventing cardiovascular events [26].

“The REDUCE-IT trial focused on studying icosapent ethyl, a form of omega-3 FA, administered at a dosage of 2 g twice daily with meals. This trial spanned five years and included nearly 5000 participants. The findings revealed that individuals in the active treatment group were 25% less likely than the comparison group to develop unstable angina, undergo coronary revascularization, experience non-fatal myocardial infarction, and suffer a stroke [27).

Following the positive outcomes from the REDUCE-IT trial, the FDA granted approval to EPA in December 2019 for use in patients with triglyceride levels >150 mg/dL, established cardiovascular disease or diabetes, and two or more additional risk factors for cardiovascular disease. This underscores the potential of specific formulations and dosages of omega-3 FAs in reducing cardiovascular events in high-risk individuals [28].”

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