Items which should not routinely be prescribed in primary care - omega-3 fatty acid compounds (excluding icosapent ethyl [Vazkepa®]) by all Sub-ICB Locations

The summary of national guidance for lipid management outlines the clinical pathway for primary and secondary prevention of cardiovascular disease (CVD). It states that omega-3 fatty acids should not be offered alone or in combination with a statin for the prevention of CVD. This pathway should be followed for lipid management.

NICE recommends that only one omega-3 fatty acid compound is recommended in specific clinical circumstances - icosapent ethyl [Vazkepa®], and that all other omega-3 fatty acid compounds are not suitable for prescribing:

• Do not offer or advise people to use omega-3 fatty acid capsules or omega-3 fatty acid supplemented foods to prevent another myocardial infarction. If people choose to take omega-3 fatty acid capsules or eat omega-3 fatty acid supplemented foods, be aware that there is no evidence of harm.
• Do not offer omega-3 fatty acid compounds for the prevention of cardiovascular disease to any of the following: people who are being treated for primary prevention, people who are being treated for secondary prevention, people with chronic kidney disease, people with type 1 diabetes, people with type 2 diabetes.
• Do not offer the combination of a bile acid sequestrant (anion exchange resin), fibrate, nicotinic acid or omega-3 fatty acid compound with a statin for the primary or secondary prevention of CVD.
• Do not offer omega-3 fatty acids to adults with non-alcoholic fatty liver disease because there is not enough evidence to recommend their use.
• Initiation of omega-3-acid ethyl esters supplements is not routinely recommended for patients who have had a myocardial infarction (MI) more than 3 months earlier.
• Do not use omega-3 fatty acids to manage sleep problems in children and young people with autism.
• People with familial hypercholesterolemia (FH) should not routinely be recommended to take omega-3 fatty acid supplements.
• Do not offer omega-3 or omega-6 fatty acid compounds to treat multiple sclerosis (MS). Explain that there is no evidence that they affect relapse frequency or progression of MS.

The joint clinical working group agreed with NICE recommendations and considered omega-3 fatty acid compounds suitable for inclusion in this guidance.