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Elevation of low-density lipoprotein cholesterol concentration with over-the-counter fish oil supplementation.
Ann Pharmacother. 2007 Jul; 41(7):1296-300.AP

Abstract

OBJECTIVE

To report a case of elevated low-density lipoprotein cholesterol (LDL-C) concentration in a patient taking fish oil supplements for hypertriglyceridemia.

CASE SUMMARY

A 63-year-old white woman had been taking 2.7 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) daily in 9 g of over-the-counter (OTC) fish oil capsules for triglyceride lowering. Prior to the adverse event, she had baseline fasting triglyceride (TG) and LDL-C concentrations of 278 mg/dL and 106 mg/dL, respectively. After 6 weeks of treatment with fish oil, fasting TG levels decreased by 47.5% (-132 mg/dL) and the LDL-C increased by 75% (+80 mg/dL). Discontinuation of therapy for 6 weeks resulted in TG returning to high concentrations (334 mg/dL; +56 mg/dL change from baseline) and LDL-C decreasing toward baseline (143 mg/dL; +37 mg/dL change from baseline).

DISCUSSION

Fish oil, an omega-3 polyunsaturated fatty acid, consists of EPA and DHA. EPA and DHA are thought to inhibit the synthesis of triglycerides in the liver. Type IV dyslipidemic patients may develop increased LDL-C levels while taking fish oil to lower triglycerides due to possible down-regulation of the LDL-C receptor in hepatic cells and formation of larger LDL particles. Use of the Naranjo probability scale indicates a probable relationship between elevations in LDL-C from baseline and initiation of fish oil treatment for hypertriglyceridemia. It is unknown whether any component within this particular product could have contributed to such an unusual elevation in LDL-C.

CONCLUSIONS

This case documents a much higher LDL-C elevation associated with OTC fish oil supplementation than has been previously identified in the literature. Healthcare providers should be advised that LDL-C levels may increase with use of OTC fish oil and should monitor patients periodically for such elevations. The significance of this increase on clinical outcomes is not known.

Authors+Show Affiliations

Nesbitt School of Pharmacy and Nursing, Wilkes University, Wilkes-Barre, PA 18766, USA. jennifer.malinowski@wilkes.eduNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17609237

Citation

Malinowski, Jennifer M., and Kimberly Metka. "Elevation of Low-density Lipoprotein Cholesterol Concentration With Over-the-counter Fish Oil Supplementation." The Annals of Pharmacotherapy, vol. 41, no. 7, 2007, pp. 1296-300.
Malinowski JM, Metka K. Elevation of low-density lipoprotein cholesterol concentration with over-the-counter fish oil supplementation. Ann Pharmacother. 2007;41(7):1296-300.
Malinowski, J. M., & Metka, K. (2007). Elevation of low-density lipoprotein cholesterol concentration with over-the-counter fish oil supplementation. The Annals of Pharmacotherapy, 41(7), 1296-300.
Malinowski JM, Metka K. Elevation of Low-density Lipoprotein Cholesterol Concentration With Over-the-counter Fish Oil Supplementation. Ann Pharmacother. 2007;41(7):1296-300. PubMed PMID: 17609237.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Elevation of low-density lipoprotein cholesterol concentration with over-the-counter fish oil supplementation. AU - Malinowski,Jennifer M, AU - Metka,Kimberly, Y1 - 2007/07/03/ PY - 2007/7/5/pubmed PY - 2007/8/11/medline PY - 2007/7/5/entrez SP - 1296 EP - 300 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 41 IS - 7 N2 - OBJECTIVE: To report a case of elevated low-density lipoprotein cholesterol (LDL-C) concentration in a patient taking fish oil supplements for hypertriglyceridemia. CASE SUMMARY: A 63-year-old white woman had been taking 2.7 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) daily in 9 g of over-the-counter (OTC) fish oil capsules for triglyceride lowering. Prior to the adverse event, she had baseline fasting triglyceride (TG) and LDL-C concentrations of 278 mg/dL and 106 mg/dL, respectively. After 6 weeks of treatment with fish oil, fasting TG levels decreased by 47.5% (-132 mg/dL) and the LDL-C increased by 75% (+80 mg/dL). Discontinuation of therapy for 6 weeks resulted in TG returning to high concentrations (334 mg/dL; +56 mg/dL change from baseline) and LDL-C decreasing toward baseline (143 mg/dL; +37 mg/dL change from baseline). DISCUSSION: Fish oil, an omega-3 polyunsaturated fatty acid, consists of EPA and DHA. EPA and DHA are thought to inhibit the synthesis of triglycerides in the liver. Type IV dyslipidemic patients may develop increased LDL-C levels while taking fish oil to lower triglycerides due to possible down-regulation of the LDL-C receptor in hepatic cells and formation of larger LDL particles. Use of the Naranjo probability scale indicates a probable relationship between elevations in LDL-C from baseline and initiation of fish oil treatment for hypertriglyceridemia. It is unknown whether any component within this particular product could have contributed to such an unusual elevation in LDL-C. CONCLUSIONS: This case documents a much higher LDL-C elevation associated with OTC fish oil supplementation than has been previously identified in the literature. Healthcare providers should be advised that LDL-C levels may increase with use of OTC fish oil and should monitor patients periodically for such elevations. The significance of this increase on clinical outcomes is not known. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/17609237/Elevation_of_low_density_lipoprotein_cholesterol_concentration_with_over_the_counter_fish_oil_supplementation_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1H695?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -