LIPIDS AND EMERGING RISK FACTORS: Edited by Dimitri P. Mikhailidis and Anthony S. WierzbickiOmega-3 fatty acid therapy for cardiovascular disease: justified or not?Maki, Kevin C.a,b; Dicklin, Mary R.aAuthor Information aMidwest Biomedical Research, Addison, Illinois, Boca Raton, Florida bDepartment of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana, USA Correspondence to Kevin C. Maki, PhD, Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN 47401, USA. Tel: +1 630 469 6600; e-mail: email@example.com Current Opinion in Cardiology: July 2020 - Volume 35 - Issue 4 - p 417-422 doi: 10.1097/HCO.0000000000000741 Buy Metrics Abstract Purpose of review To discuss the current evidence regarding the relationship between omega-3 fatty acid intake and atherosclerotic cardiovascular disease (ASCVD) risk. Recent findings Combined results from randomized controlled trials using low-dosage (≤1.8 g/day of ethyl esters) eicosapentaenoic acid (EPA) or EPA + docosahexaenoic acid (DHA) suggest a small benefit for reducing coronary heart disease risk. The Reduction of Cardiovascular Events with EPA-Intervention Trial (REDUCE-IT) that administered 4 g/day icosapent ethyl (IPE) to individuals on statin at high or very high ASCVD risk with elevated triglycerides demonstrated a 25% relative risk reduction in the composite primary endpoint (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization and unstable angina) for IPE vs. placebo, and a lower hazard for all prespecified individual endpoints other than total mortality. Several national organizations have recommended IPE for ASCVD risk reduction in populations aligning with REDUCE-IT; the Food and Drug Administration has approved IPE for ASCVD risk reduction. However, the Outcomes Study to Assess Statin Residual Risk Reduction with Epanova (EPA + DHA carboxylic acids) in High Cardiovascular Risk Patients with Hypertriglyceridemia was recently stopped for futility. Summary At present, the best available evidence for a role of omega-3 fatty acids in ASCVD risk reduction is for 4 g/day of IPE, as an adjunct to statin therapy, for patients with ASCVD or diabetes mellitus and elevated triglycerides. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.