Deaths caused by cardiovascular disease are generally premature and could easily, in some cases, be prevented by making lifestyle changes that include adopting a healthy lifestyle and increasing physical activity.
The role of lipid lowering (cholesterol and triglyceride) in reducing the risk of mortality and morbidity from cardiovascular disease is well documented. The cardiovascular benefits of omega-3, certainly in terms of cholesterol and triglyceride management, are probably the most researched of all the dietary nutrients known to influence cardiovascular disease risk. With the recent approval of the use of pure eicosapentaenoic acid (EPA) as a prescription treatment for hypertriglyceridemia  and with overwhelming evidence for EPA’s role over docosahexaenoic acid (DHA) in cholesterol management,  consumers should be aware of the differential effects of the two main omega-3s, EPA and DHA, on cardiovascular disease risk factors and why they should choose isolated EPA over generic fish oil.
EPA and lipid management
Whilst fish oil provides a convenient dietary intervention for maintaining heart health, the differential effects of the two main long-chain omega-3s, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on cardiovascular disease risk factors means that not all fish oil products are equal in their action.
Firstly, generic oils generally contain around 30% total omega-3 and are therefore not considered viable as a therapeutic. For example, the optimal triglyceride-lowering doses of omega-3 are 3-4g/day, with little evidence to support lipid-altering efficacy in doses of less than 1g/day.  In addition to providing a soluble means for transporting cholesterol and triglycerides through the blood, lipoproteins have cell-targeting signals that direct the lipids they carry to certain tissues.
Whilst high density lipoproteins (HDL) correlate with better health outcomes, effectively clearing cholesterol from the system, low density lipoproteins (LDL) are, in contrast, considered the cholesterol ‘bad boy’ and are responsible for the detrimental effects associated with total cholesterol.
Both EPA and DHA decrease triglyceride levels, and whilst EPA lowers LDL levels, DHA appears to increase LDL levels [4, 5]. Given that products that contain a mixture of EPA and DHA may increase LDL levels, the benefits of a pure EPA product understandably extend to both cholesterol and triglyceride management. Indeed, the cholesterol-lowering ability of pure EPA at a dose of 1.8 grams in a study of approximately 19,000 statin-treated patients with hypercholesterolaemia was shown to reduce the 5-year cumulative risk of major coronary events by 19%. Igennus’ Pharmepa Step 1: Restore (E-EPA 90) contains the purest ethyl-EPA concentrate available (90%) without prescription, delivers 1g pure EPA in just two easy-to-swallow capsules, and is ideal for those individuals wanting to manage cholesterol and triglyceride levels.
AA to EPA ratio and cardiovascular health
In addition to altering lipid metabolism, omega-3 may also improve cardiovascular health by inhibiting inflammatory products derived from the key pro-inflammatory fatty acid arachidonic acid (AA). AA and EPA are converted through phospholipase A2, cyclooxygenase (COX) and lipooxygenase (LOX) to prostaglandins, thromboxanes and leukotrienes, as well as various hydroxyl-fatty acids, and the AA to EPA ratio provides an established risk factor for numerous inflammatory-related conditions, including poor cardiovascular health. Indeed, inﬂammation is an important process in the development of cardiovascular disease; chronic inﬂammation, characterised by elevated plasma levels of inﬂammatory markers such as C-reactive protein (CRP) and IL-6, are commonly found in subjects at high cardiovascular risk, including type2 diabetics and patients with coronary heart disease.  Supplementing with EPA, in addition to triglyceride and cholesterol improvement, increases EPA blood levels, improves the AA to EPA ratio (which directly correlates with changes in improved LDL levels) and reduces cardiovascular related inflammation. 
In summary, EPA, unlike DHA, lowers levels of triglyceride, lowers ‘bad’ cholesterol and increases ‘good’ cholesterol, whilst reducing inflammation via management of the AA to EPA ratio. By providing pure isolated EPA at the concentrations required for therapeutic outcomes, Igennus’ Pharmepa range of EPA products are ideal health supplements for managing optimal heart health by managing lipid levels and modulating dysregulated inflammation. The prescription-strength ethyl-EPA Pharmepa Restore & MaintainTM protocol is an innovative two-step treatment programme formulated to re-establish a healthy inflammatory status within the body. Step 1 counteracts an unhealthy AA to EPA ratio – the direct measure of inflammatory status, and step 2 ensures long-term balance for optimal cardiovascular health benefits.
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2. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, et al: Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007, 369:1090-1098.
3. Pirillo A, Catapano AL: Omega-3 polyunsaturated fatty acids in the treatment of hypertriglyceridaemia. International journal of cardiology 2013.
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6. Brevetti G, Giugliano G, Brevetti L, Hiatt WR: Inflammation in peripheral artery disease. Circulation 2010, 122:1862-1875.
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