To the Editor I am concerned that the STRENGTH trial did not have adequate treatment adherence, as evidenced by plasma EPA and DHA levels that increased by 269% and 40%, respectively, after treatment with omega-3 fatty acids for 12 months. This increase was lower than expected because the authors had previously shown that treatment with the same omega-3 formulation at the same dose for 3 months increased plasma EPA and DHA by 406% and 72%, respectively. Another report demonstrated that treatment with a similar omega-3 formulation at the same dose for 2 months increased EPA and DHA by 402% and 86%, respectively. In addition, in REDUCE-IT, treatment with EPA at 4 g/d for 12 months increased plasma EPA by 386%.
