Knowledge, perceptions, and patterns of fish oil use in cardiac patients

BACKGROUND: Intake of 500 mg/day of fish oil-derived omega-3 fatty acids is recommended by dietetic/nutrition organizations as a means of general health promotion. However, fish oil dietary supplements are not medications and are not approved or indicated for the treatment of any disease. In contrast, prescription omega-3s are approved as an adjunct to diet for the treatment of adults with severe hypertriglyceridemia and are under clinical investigation for potential reduction of residual cardiovascular risk/events in large randomized clinical outcomes trials. While fish oil dietary supplements comprise a large portion of the dietary supplement market, little is known about patient knowledge and patterns of use. OBJECTIVE: To determine cardiac patients knowledge and patterns of use of fish oil-derived dietary supplement and prescription products. METHODS: 1,000 consecutive patients admitted to an inpatient cardiology service during 2015-2017 who indicated taking fish oil dietary supplements or an omega-3 prescription product on their admitting patient history were asked to complete an anonymous, written questionnaire concerning their knowledge and use of fish oil products. RESULTS: 711 patients (71%) completed the questionnaire (mean age, 70.3 years; 57% women; 68% white). Primary reasons for fish oil product use included general health (34%), heart health (28%), arthritis (9%), and lipid disorders (8%). Relatively few patients (14%) indicated they were advised to take a fish oil product by a healthcare provider. Only 2.5% of patients indicated they were taking a prescription omega-3 product. Only 26% of patients knew the active ingredient in their fish oil product. Regarding pill burden, 86% indicated they were taking one (42%) or two (44%) capsules per day. Fish oil products were purchased through a non-pharmacy retail seller by 81% of patients. Regarding costs, 59% of patients paid $15-25/month and 27% paid > $25/month. CONCLUSIONS: Most cardiac patients are consuming fish oil products without medical supervision. As most fish oil dietary supplements contain well below 1 gram of omega-3s per capsule, the daily dose that most patients are taking is relatively low. While low-dose omega-3 supplementation may be beneficial in general promotion of health, there is little to no clinical evidence supporting clinical benefit for such low doses in the treatment of any disease. As most patients obtain fish oil dietary supplements outside of a pharmacy, opportunities to monitor and educate patients concerning fish oil product use remain major challenges.