Omega-3 (high dose)
What it is
High-dose omega-3 (≥2 g/day EPA+DHA) targeted at hypertriglyceridemia (>500 mg/dL) and secondary cardiovascular prevention. The 2024 Tseng network meta-analysis (PMID 39805484) confirms 2,000–4,000 mg/day for ≥1 year improves LV ejection fraction in heart failure. SAFETY UPDATE (O'Keefe 2024 PMID 39617283): RCTs at 1.8–4 g/day showed a ~50% increase in atrial-fibrillation risk (dose-dependent, vagally-mediated). Always coordinate with your cardiology team and check baseline rhythm before high-dose use.
Dose
Triglyceride reduction / cardiovascular risk: 2–4 g/day EPA+DHA with a fatty meal; prescription EPA-only (icosapentaenoic acid, Vascepa) 4 g/day is the only formulation with REDUCE-IT evidence. Over-the-counter fish oil at equivalent doses is a lower-cost alternative with weaker evidence.
Time of day & tips
Always inform your doctor and pharmacist if taking 2 g/day or more alongside blood thinners, antiplatelets, or anticoagulants — the additive bleeding risk is real and dose-dependent. Take with the largest meal of the day (with dietary fat) for best absorption; split into two doses with breakfast and dinner if >2 g/day. Space at least 4 hours from blood thinners.
Cycling
Safe for long-term continuous use under medical supervision. No cycling needed. Triglyceride-lowering benefit requires sustained daily use — effects reverse within weeks of stopping. Benefits are cumulative over months.
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