Omega-3 (high dose)

Tier 2 — promising · Drug interactions · Anticoagulants · Cardiovascular

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.