Will Prescription EPA Prevent Heart Attacks?

Vascepa is a prescription pill containing one of the types of omega-3 fatty acids found in fish oil (eicosapentaenoic acid, or EPA for short). This medication, icosapent ethyl, is prescribed for people with stubbornly high triglycerides. High triglycerides are an independent risk factor for heart disease. Will this prescription EPA prevent heart attacks? We recently fielded an inquiry from a reader.

What Do You Think of Vascepa?

Q. What do you think of Vascepa? I understand it is a kind of purified fish oil with only EPA. That means it has no contaminants such as mercury.
EPA is a strong anti-inflammatory. It contains no DHA.

A. Vascepa (icosapent ethyl) is a highly purified form of the omega-3 fatty acid, eicosapentaenoic acid (EPA). Doctors prescribe it to lower triglyceride levels and reduce the risk of heart attacks and strokes.

Many consumers opt for over-the-counter fish oil capsules to reduce inflammation. Such products often contain both EPA and DHA (docosahexaenoic acid). They are less expensive and some research indicates that people taking them are less prone to cardiovascular disease (BMJ, March 4, 2020).

EPA for the Brain:

A new study suggests that EPA-rich supplements improve performance on tests of verbal fluency, word recall, reaction time and numeric working memory as well as rapid visual information processing (American Journal of Clinical Nutrition, Sept. 2021). This study was conducted with fish oil from BASF and not with Vascepa.

Side effects of Vascepa include an increased risk of atrial fibrillation or of excessive bleeding. Other complications may include muscle and joint pain, gout, edema and constipation.

Studying Prescription EPA:

In 2019, researchers reported that people taking Vascepa are 25 percent less likely than those on placebo medicines to suffer a heart attack, stroke, or other serious heart problem. The principal study included more than 19,000 people with heart disease or serious risk factors for heart disease. More than 8,000 of these volunteers participated in the placebo-controlled trial called REDUCE-IT. 

About 6 percent of those on Vascepa suffered a heart attack during the year-long study, compared to 8.7 percent of those on placebo. Serious side effects included atrial fibrillation and severe bleeding events. The investigators presented their findings at the American College of Cardiology Scientific Meeting in New Orleans, LA, on March 18, 2019.

Previous Findings from the REDUCE-IT Study:

An earlier report on the REDUCE-IT trial was published in The New England Journal of Medicine (Jan. 3, 2019). This randomized placebo-controlled trial included more than 8,000 high-risk patients for nearly five years. All the participants had heart disease or diabetes and high triglycerides despite being treated with statins.

About 17 percent of the volunteers taking icosapent ethyl had a heart attack, stroke, death from cardiovascular complications or hospitalization for heart procedures. In comparison, 22 percent of those on placebo suffered one of these events.

Fewer People Died:

The most important outcome of any trial is mortality. Did the treatment keep people from dying prematurely?

The previous report showed that fewer people taking Vascepa died from cardiovascular causes. The totals were 4.3 percent instead of 5.2 percent of those on placebo. With more follow-up, 9.6 of those on Vascepa vs.12.4 percent of those on placebo died of heart attacks or other cardiovascular complications. This difference is significant. On the other hand, the difference in overall mortality was not significant.

In summary, the bottom line appears to be that prescription EPA (eicosapentaenoic acid, aka icosapent ethyl or Vascepa) has cardioprotective activity. However, the effect may not be powerful enough to cheat death.