Abstract
In this exploratory, hypothesis-generating literature review, we evaluated potentially
differential effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
on low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol
(HDL-C), triglycerides (TG), and non-HDL-C in published studies of ω-3 fatty acid
supplementation or prescription ω-3 fatty acid ethyl esters. Placebo-adjusted changes
in mean lipid parameters were compared in randomized, controlled trials in subjects
treated for ≥4 weeks with DHA or EPA. Of 22 studies identified, 6 compared DHA with
EPA directly, 12 studied DHA alone (including 14 DHA–treated groups), and 4 examined
EPA alone. In studies directly comparing EPA with DHA, a net increase in LDL-C of
3.3% was observed with DHA (DHA: +2.6%; EPA: −0.7%). In such head-to-head comparative
studies, DHA treatment was associated with a net decrease in TG by 6.8% (DHA: −22.4%;
EPA: −15.6%); a net increase in non-HDL-C by 1.7% (DHA: −1.2%; EPA −2.9%); and a net
increase in HDL-C by 5.9% (DHA: +7.3%; EPA: +1.4%). Increases in LDL-C were also observed
in 71% of DHA-alone groups [with demonstrated statistical significance (P < .05) in 67% (8 of 12) DHA-alone studies] but not in any EPA-alone studies. Changes
in LDL-C significantly correlated with baseline TG for DHA-treated groups. The range
of HDL-C increases documented in DHA-alone vs EPA-alone studies further supports the
fact that HDL-C is increased more substantially by DHA than EPA. In total, these findings
suggest that DHA-containing supplements or therapies were associated with more significant
increases in LDL-C and HDL-C than were EPA-containing supplements or therapies. Future
prospective, randomized trials are warranted to confirm these preliminary findings,
determine the potential effects of these fatty acids on other clinical outcomes, and
evaluate the generalizability of the data to larger and more heterogeneous patient
populations.
Keywords
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Article info
Publication history
Published online: November 04, 2011
Accepted:
October 23,
2011
Received:
April 4,
2011
Identification
Copyright
© 2012 National Lipid Association. Published by Elsevier Inc. All rights reserved.
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- EPA and DHA: Distinct yet essential n-3 fatty acidsJournal of Clinical LipidologyVol. 6Issue 5
- PreviewIn the article “The effects of eicosapentaenoic acid and docosahexaenoic acid on low-density lipoprotein cholesterol and other lipids: a review,” Jacobson et al1 evaluated the differential effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on various lipid parameters, such as low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and non-HDL-C. The premise of the review was to understand the relative and potentially disparate impacts that EPA and DHA have on these lipids, presumably to clear the way for use of isolated EPA in the population of patients with high levels of TG.
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