Combination of Fish Oil and Metformin Could Help Alleviate Burden of Dyslipidemia in Young Women with Polycystic Ovary Syndrome

New data from a pilot trial conducted by investigators in Canada suggests metformin combined with therapeutic doses of fish oil could help relieve the burden of dyslipidemia among women with polycystic ovary syndrome (PCOS).

A 3-arm, open-label trial, results indicate combination of high dose fish oil and metformin for 12 weeks was associated with significant reductions in fasting plasma triglycerides and ApoB-remnants when compared to treatment with metformin or high dose fish oil alone.

“These results may be clinically significant for management of fasting and non-fasting atherogenic dyslipidemia and prevention of early ACVD in these individuals. PCOS women with MetS are at higher risk for the development of ACVD, and nutrition-lifestyle counseling combined with FO-Metformin and/or other treatments used in PCOS may form a polytherapeutic approach to prevent early ACVD,” wrote investigators.

With an increased prevalence of dyslipidemia among patients with PCOS, investigators from the University of Alberta conducted the current trial to assess the safety and efficacy of interventions combining healthy diet and lifestyle counseling with either high dose fish oil, metformin, or a combination of both on fasting and non-fasting plasma triglycerides, and ApoB48 and ApoB100-lipoprotein remnant concentrations. With an open-label, parallel design, the trial enrolled 29 young women with PCOS from endocrine clinics in Alberta and randomized them to metformin 1.5 mg daily, fish oil containing 2.52 g of EPA and 1.68 g of DHA daily, or both for 12 weeks.

All patients included in the study were 18-30 years of age and had features of metabolic syndrome. Patients who were taking oral contraceptives, metformin, non-required medications, nutraceuticals, or special diets were required to withdraw from these, if medically appropriate, and an 8-week washout period was initiated before starting the intervention.

The primary outcomes of interest in the analysis were change in plasma lipids, ApoB-lipoproteins, and triglycerides, which were measured in the fasted and postprandial state following a high-fat meal at baseline and following the intervention period.

Upon analysis, investigators found no difference in fasting plasma concentrations for LDL-C, HDL-C, or non-HDL-C as well as ApoB48 or ApoB100-remnant lipoproteins between the study arms at baseline or intervention. Results indicated patients in the combination group experienced reductions of fasting plasma triglycerides greater than 40% compared to fish oil and metformin treatments. Additionally, investigators pointed out fasting plasma ApoB48 was lowered by 40% in the combination group and 15% in the fish oil group from baseline to post-intervention follow-up.

Investigators also pointed out the results of their trial suggested ApoB48 area under the curve (AUC), ApoB48 incremental area under the curve (IAUC), ApoB100 AUC, and ApoB100 IAUC decreased in all groups from baseline to the post-intervention follow-up, but these failed to reach statistical significance.

“The findings of this pilot trial show high dose fish oil and fish oil-metformin combination therapy tend to lower fasting and post-prandial plasma TG and ApoB-lipoprotein remnants to a greater extent compared to metformin alone in young women with PCOS and MetS,” wrote investigators.

This study, “A Pilot Trial: Fish Oil and Metformin Effects on ApoB-Remnants and Triglycerides in Women with Polycystic Ovary Syndrome,” was published in the Journal of the Endocrine Society.