The National Institute for Health and Care Excellence (NICE) has published “Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease” with unfavorable omega-3 recommendations, including the following:
Omega-3 fatty acid compounds for preventing CVD
Recommendations in this section update and replace the following recommendations from Type 2 diabetes (NICE clinical guideline 87):
- 18.104.22.168 Do not prescribe fish oil preparations for the primary prevention of cardiovascular disease in people with type 2 diabetes. This recommendation does not apply to people with hypertriglyceridaemia receiving advice from a healthcare professional with special expertise in blood lipid management.
22.214.171.124 Consider a trial of highly concentrated, licensed omega-3 fish oils for refractory hypertriglyceridaemia if lifestyle measures and fibrate therapy have failed.
1.3.48 Do not offer omega-3 fatty acid compounds for the prevention of CVD to any of the following:
- people who are being treated for primary prevention
- people who are being treated for secondary prevention
- people with CKD
- people with type 1 diabetes
- people with type 2 diabetes. [new 2014]
1.3.49 Tell people that there is no evidence that omega-3 fatty acid compounds help to prevent CVD. [new 2014]
Combination therapy for preventing CVD
1.3.50 Do not offer the combination of a bile acid sequestrant (anion exchange resin), fibrate, nicotinic acid or omega-3 fatty acid compound with a statin for the primary or secondary prevention of CVD. [new 2014]
Last November, GOED reported that NICE published its final updated revision to the 2007 report “MI – secondary prevention: Secondary prevention in primary and secondary care for patients following a myocardial infarction,” which included a retraction of support for omega-3s as protection against future heart attacks. Ironically, NICE explained the retraction as being due to one of the more popular theories of why many of the omega-3 studies in recent years may have failed to detect an effect - the change in the standard of treatment with an increased number of prescription cardio-drugs.
The guideline is meant for government, the National Health Service, local authorities, industry and all those whose actions influence the population's cardiovascular health.