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Table 3 Summary of key findings

From: Omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and their mechanisms of action on apolipoprotein B-containing lipoproteins in humans: a review

• There is no clear difference between DHA and EPA with respect to reducing fasting or postprandial TG levels.

• The major mechanism explaining reduced fasting serum TG associated with OM3FA treatment is reduced VLDL production, including a reduced number and size of VLDL particles. The reduced VLDL production results in a faster conversion of VLDL particles to IDL and LDL.

• OM3FA supplementation partly corrects the underlying disorder responsible for the atherogenic dyslipidemia in patients with type 2 diabetes by reducing hepatic production of VLDL1.

• Potential mechanisms for the inhibitory effect of OM3FAs on VLDL production include improved hepatic insulin sensitivity, reduced liver fat and increased whole-body fatty acid oxidation.

• There is a relationship between DHA and the apoE4 isoform of apoE, which results in an increased production of LDL from VLDL as well as in a reduced hepatic uptake of LDL via competition with apoE4-enriched VLDL2. Therefore, patients with the apoE4 variant could contribute to an overall increase in LDL-C in trials using OM3FA formulations containing DHA.

• OM3FAs increase LPL activity, likely by increased expression of the gene and reflected as increased pre-heparin LPL activity. Increased LPL activity can explain the higher clearance rate of TG-rich lipoproteins postprandially, but normally not in the fasted state because LPL capacity is not rate-limiting when TG levels are not high.

• Treatment with OM3FAs reduces plasma levels of PCSK9, but does not reduce LDL-C levels. Therefore, PCSK9 is unlikely to be of major importance for LDL-C levels following treatment with OM3FA.

  1. Apo apolipoprotein, DHA docosahexaenoic acid, EPA eicosapentaenoic acid, IDL intermediate-density lipoprotein, LDL low-density lipoprotein, LDL-C low-density lipoprotein cholesterol, LPL lipoprotein lipase, OM3FA omega-3 fatty acid, PCSK9 proprotein convertase subtilisin/kexin type 9, TG triglyceride, VLDL very-low-density lipoprotein
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Lipids in Health and Disease

ISSN: 1476-511X