N-3 Polyunsaturated Fatty Acids and Their Role on Cardiovascular System

The interest in n-3 polyunsaturated fatty acids (n-3 PUFAs), their favorable effects on the cardiovascular (CV) risk profile and prevention of CV events has been growing over the years, leading to their recommendation for secondary prevention in post myocardial infarction and hypertriglyceridemia. However, years later conflicting results provided by clinical trials have generated some doubts about their CV benefits, leading to a limited indication for the treatment of hypertriglyceridemia. Only recently, after the REDUCE-IT Trial results on CV events and mortality, n-3 PUFAs have recovered an indication in the international guidelines for hypertriglyceridemia in patients with Atherosclerotic Cardiovascular Disease (ASCVD) or with type 2 diabetes mellitus (T2DM) and other CV risk factors, already on statin therapy. Multiple beneficial CV effects have been highlighted, in addition to the well-known lipid-lowering function, such as anti-inflammatory, anti-thrombotic and endothelial function protective properties. Three formulations of n-3 PUFAs are currently available on the market, sharing some pharmacokinetic and pharmacodynamic characteristics, but also exhibiting peculiar mechanisms. Three major clinical trials evaluated the efficacy and safety of different formulations of n-3 PUFA: JELIS, REDUCE-IT and STRENGTH, with controversial results attributable to various factors. For the future, it could be useful to perform comparative studies between different formulations and placebo, in order to clarify these doubts.