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Clinical Trial
. 2015 May-Jun;9(3):326-33.
doi: 10.1016/j.jacl.2015.02.004. Epub 2015 Feb 21.

Over-the-counter fish oil use in a county hospital: Medication use evaluation and efficacy analysis

Amulya Tatachar  1 , Margaret Pio  2 , Denise Yeung  2 , Elizabeth Moss  2 , Diem Chow  2 , Steven Boatright  2 , Marissa Quinones  2 , Annie Mathew  2 , Jeffrey Hulstein  2 , Beverley Adams-Huet  3 , Zahid Ahmad  4
Affiliations
Clinical Trial

Over-the-counter fish oil use in a county hospital: Medication use evaluation and efficacy analysis

Amulya Tatachar et al. J Clin Lipidol. 2015 May-Jun.

Abstract

Background: Little is known about the use and effectiveness of over-the-counter (OTC) fish oil supplements for triglyceride (TG) lowering.

Objectives: To (1) perform a medication-use evaluation (MUE) and (2) assess the efficacy of OTC fish oil.

Methods: Retrospective, observational cohort study using electronic medical records and the pharmacy database from Parkland Health and Hospital System in Dallas, Texas. Parkland is a tax-supported county institution that provides patients with single-brand OTC fish oil. Two separate analyses were conducted. Six hundred seventeen patients (prescribed fish oil between July 1, 2012, and August 31, 2012) were included in the MUE analysis and 235 patients (109 fish oil, 72 fenofibrate, and 54 gemfibrozil, prescribed between January 1, 2012, and July 31, 2013) were included in the efficacy analysis. The main outcome measure for the MUE was fish oil prescribing habits including dosages and patient adherence, as defined by medication possession ratio. The main outcome measure for the efficacy analysis was change in lipids measured using the last value before fish oil treatment and the first value after fish oil treatment.

Results: MUE: 617 patients received prescriptions for OTC fish oil. Sixty-four percent were prescribed a total daily dose of 2000 mg. Only 25% of patients were adherent. Efficacy analysis: despite being prescribed suboptimal doses, fish oil reduced TGs by 29% (95% confidence interval, 34.3-22.7). Compared with fish oil therapy, fibrate therapy resulted in a greater TG reduction: 48.5% (55.1-41.0) with fenofibrate and 49.8% (57.6-40.5) with gemfibrozil (P < .0001, both medications compared with fish oil).

Conclusions: Health care providers prescribe suboptimal doses of fish oil, and adherence is poor. Even at low doses (2 g/d), though, fish oil lowers TGs by 29%.

Keywords: Fenofibrate; Fish oil; Gemfibrozil; Hypertriglyceridemia; Marine omega-3 fatty acids.

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Figures

Figure 1
Figure 1
Medication use evaluation: total daily doses of fish oil prescribed by health care providers within the Parkland Hospital & Health System.
Figure 2
Figure 2
Pretreatment and posttreatment lipid and lipoprotein levels for patients prescribed fish oil, fenofibrate, or gemfibrozil (left). Response for each treatment (right) presented as the percentage change from the pretreatment; geometric mean and 95% confidence interval. Left: *P < .001 compared with fish oil. The lower and upper limits of the box indicate the 25th and 75th percentiles, the line within the box depicts the median, and the whiskers (error bars) below and above the box indicate the 10th and 90th percentiles. Right: *P < .005 compared with pretreatment; †P < .05 compared with fish oil; ‡P < .05 compared with fenofibrate. HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.
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References

    1. Bang HO, Dyerberg J, Sinclair HM. The composition of the Eskimo food in north western Greenland. Am J Clin Nutr. 1980;33(12):2657–2661. - PubMed
    1. Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012;308(10):1024–1033. - PubMed
    1. Investigators OT, Gerstein HC, Bosch J, Dagenais GR, Diaz R, Jung H, et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med. 2012;367(4):319–328. - PubMed
    1. Investigators OT, Bosch J, Gerstein HC, Dagenais GR, et al. n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med. 2012;367(4):309–318. - PubMed
    1. Kromhout D, Giltay EJ, Geleijnse JM. Alpha Omega Trial G. n-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med. 2010;363(21):2015–2026. - PubMed