The Korean Society of Lipid and Arteriosclerosis (KSoLA) subdivided the use of omega 3 into the use of ‘high dose and refined ingredients’ by revealing the full version of the 5th edition of the dyslipidemia treatment guideline. Although effectiveness has been debated, this guideline emphasizes the fact that the benefits of medication still outweigh the lack of medication.
On the 22nd, ‘2023 KSoLA Guideline Update’, ‘Guideline Evidence’, ‘Limitations in the Evidence’ was held at the Cardiovascular Integration Academic Conference held by 8 societies including the Korean Heart Association, Korean Arrhythmia Society, Korean Heart Association. Failure, and the Lipid Arteriosclerosis Association. The content of ‘dot’ was revealed.
Last year, a simplified amendment was published, but this year, the full version was released to support the details and rationale.
The newly changed content in the 5th edition of dyslipidemia is mainly divided into ▲diagnosis method and criteria ▲treatment criteria.
First, the diagnosis method and diagnostic criteria presented the result that the triglyceride level in the non-fasting state showed a high correlation with the risk of cardiovascular disease.
In terms of treatment criteria, it was recommended that patients with coronary artery disease reduce their target LDL cholesterol level from less than 70 mg/dL to less than 55 mg/dL and reduce it by more than 50% from baseline.
In the case of diabetes, the goal is less than 70 mg/dL in the case of diabetes lasting 10 years or more, one or more additional risk factors, or target organ damage, depending on the level of risk. In addition, diabetic patients with target organ damage or three or more major cardiovascular disease risk factors may selectively consider reducing LDL cholesterol to less than 55 mg/dL.
Then, as exercise therapy, the recommendation grade for wearable use for fitness was just presented as IIa, and a method for using wearable equipment and a strategy for promoting physical activity were also suggested.
In the full text, he took a somewhat reserved position on omega 3, which was plagued by controversy over its cardiovascular protective effect.
Professor Yang Ye-seul (Department of Endocrinology, Seoul National University Hospital), who published the ‘New Changes in KSoLA Guidelines’, said, “The 5th edition of the revised guidelines subdivided and strengthened the treatment criteria and treatment targets for dyslipidemia . “Different standards of treatment were recommended.”
He said, “We introduced individual guidelines for special groups such as stroke, chronic kidney disease, the elderly, adolescents, and familial hypercholesterolemia. The role of fibrate and omega 3 fatty acids for triglyceride control was explained and the introduction of icosapent ethyl (IPE) preparations. “
As for whether omega 3 actually shows a protective effect against cardiovascular disease, large-scale studies have come to different conclusions. The most recent study that proved the effectiveness was seen when only IPE was isolated from the omega-3 components and used in high doses.
The Society tries to reduce LDL cholesterol to below the target level with statins, etc. in patients with atherosclerotic cardiovascular disease or diabetes.
It was newly included in the recommendation to use IPE in patients with hypertriglyceridemia even after withdrawal.
The hypertriglyceridemia category is “Using fibric acid derivatives or omega-3 fatty acids that primarily lower triglycerides first (IIa, A), even after achieving LDL cholesterol below the target level by improving lifestyle therapeutic and statin drug treatment.If the triglyceride is 200 mg/dL or higher or non-HDL cholesterol is higher than the target value, drug treatment can be considered to lower the triglyceride (IIa, B).
The society said, “Recently, in the REDUCE-IT study, 4 g of IPE per day was administered in high-risk patients with atherosclerotic cardiovascular disease or diabetes, and the result of the study was published, reducing the incidence of cardiovascular disease by 26%. compared to the placebo group.” When hypertriglyceridemia of 200 mg/dL or higher persists even after improving habits and statin administration, IPE (4g per day) can be given in addition to prevent cardiovascular disease (IIb, B).
However, the association was aware of the controversy and added a condition.
The association said, “The effect of omega-3 fatty acids on reducing the risk of cardiovascular disease is still controversial because different results are shown depending on the dosage form or dose.” In patients with triglyceride levels of 135 to 499 mg/dL or higher, the use of 2 g twice daily of IPE, highly pure EPA, significantly reduced death from cardiovascular disease and the incidence of ischemic disease.”
“In the European guidelines revised in 2019, the use of IPE is recommended to control triglycerides in the high risk group of cardiovascular disease, but IPE has not yet been marketed in Korea.” In comparison, formulations containing EPA and DHA showed no benefit for cardiovascular disease, but instead increased the risk of atrial fibrillation.”
In the combination therapy of statin and omega 3, the use of high dose and high purity ingredients was emphasized.
“Combination therapy can be used when trying to reduce LDL cholesterol and triglyceride at the same time,” says the association. “The combination of 4 g omega 3 per day and simvastatin significantly lowered triglyceride and slightly increased HDL cholesterol.”
“Additional research is needed on the use of omega-3 for purposes other than lowering triglycerides, but omega-3 is relatively safe, so there are no particular side effects and few drug interactions,” he said. or higher persists after administration, IPE (4g per day) can be given in addition to prevent cardiovascular disease (IIb, B).
