Comparison of efficacy and safety of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia

Choi HD, Chae SM. Comparison of efficacy and safety of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(50):e13593. doi:10.1097/MD.0000000000013593

Abstract

Objective:

Dyslipidemia is a major risk factor for the development of cardiovascular disease. Both statins and omega-3 fatty acids demonstrate beneficial effects on lipid concentrations. The goal was to evaluate the safety and efficacy of combination therapy with statins and omega-3 fatty acids.

Methods:

We performed a systematic review and meta-analysis of published data to compare the safety and efficacy of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia. Six articles were assessed in the present meta-analysis (quantitative assessment) and qualitative assessment.

Results:

In terms of efficacy, the combination treatment afforded a significantly greater reduction in total cholesterol/high-density lipoprotein cholesterol than statin alone did [standard difference in means = −0.215; 95% confidence interval (CI) −0.359–−0.071]. However, there was no significant difference in low-density lipoprotein (LDL) cholesterol between the 2 groups. Qualitative assessment of other lipid parameters was performed. Combination therapy with statins and omega-3 fatty acids was generally more effective on lipid concentration than statin monotherapy. In terms of safety, there were no significant differences in total adverse events between the 2 groups. Gastrointestinal adverse events were found to be significantly increased in patients receiving combination therapy using the fixed-effects model (relative risk = 0.547; 95% CI 0.368–0.812).

Conclusions:

We suggest that combination therapy with statins and omega-3 fatty acids enhances lipid profile, except LDL cholesterol, compared with statin monotherapy. Nevertheless, statin and omega-3 fatty acid combination should be cautiously recommended, taking into account the clinical importance of LDL cholesterol and safety issues associated with their concomitant use.

Summary:

2 of the patients I presented had hyperlipidemia. However, one of them was only on statin therapy, while one of them was on triple therapy, including a statin, fenofibrate, and omega-3. Omega-3 (fish oil) is considered more like a “supplement,” so I was wondering if it was necessary, or beneficial, as an add-on therapy for a patient who is already on dual hyperlipidemia therapy. The article I chose is a recent systematic review and meta-analysis, which is a very high level of evidence, and looks at this question with 6 studies. According to this article, combination therapy caused a signficant decrease in total cholesterol/HDL cholesterol, but not in LDL cholesterol. It did not find any significant difference in serious adverse effects between the 2 groups, but those in the combination group had greater GI adverse effects than those in the statin alone group. Overall, based on the limited benefit of combination therapy in lowering LDL cholesterol (which is very important to control in order to prevent cardiovascular issues/ deaths) in addition to the increased adverse effects of combination therapy, this article recommends cautious use of combination therapy as compared to statin therapy alone.