A randomized trial of the effects of ezetimibe on the absorption of omega-3 fatty acids in cardiac disease patients: A pilot study

Background and aims: Elevated levels of circulating omega-3 polyunsaturated fatty acids like alpha linolenic acid (ALA) may be beneficial for cardiovascular health. Circulating ALA concentrations are elevated dramatically by a cholesterol supplemented diet which increases ALA bioavailability through enhanced micelle formation in the intestines. Conversely, it is possible that drugs which inhibit cholesterol metabolism in the intestine may also inhibit fatty acid absorption. The purpose of this study is to determine if a cholesterol absorption inhibitor, ezetimibe, will decrease circulating levels of ALA. Methods and results: Cardiac patients (n = 34) between 44 and 80 years old, requiring statin therapy to regulate blood cholesterol levels, were randomly assigned to one of four groups for a 6 week trial: 1) placebo; 2) ezetimibe therapy; 3) a supplement of flaxseed oil (containing 1.0 g ALA in 2.0 g of flaxseed oil); or 4) ezetimibe and flaxseed oil supplementation. Ingestion of flaxseed oil resulted in a significant increase in circulating ALA levels (6 ug/dl) in patients who were not given ezetimibe. However, in the presence of ezetimibe, circulating ALA levels did not increase significantly even in the presence of flax oil supplementation (a decrease of 4 ug/dl). There were no significant differences amongst the groups in terms of circulating total cholesterol, LDL, HDL, triglyceride levels in the blood. Conclusion: Ezetimibe therapy inhibited the absorption of omega-3 fatty acids. Patients receiving ezetimibe therapy may not receive the expected cardiovascular benefits from dietary supplementation with omega-3 fatty acids. (C) 2015 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.