Deep-sea fish oil has been publicized as having the efficacy of “lowering blood lipids and protecting cardiovascular and cerebral vessels”, which is very popular among the middle-aged and elderly groups. In the course of my work, many patients have asked me: Should I take deep sea fish oil for stroke? I heard that statin has side effects, can be replaced by deep sea fish oil? In order to answer this kind of questions, I have checked the latest literature and share it with you with my own experience. Deep-sea fish oil is an unsaturated fatty acid extracted from deep-sea fish (salmon, tuna, etc.), and its main components are DHA and EPA. DHA is indispensable for the formation, development and functioning of brain cells, and EPA has been proven by many studies to lower blood lipid levels. On the surface, deep-sea fish oil is indeed beneficial to health, and has a certain effect on regulating blood lipids and protecting blood vessels. But we break the problem into pieces and analyze it carefully, we will find that the truth is much more complex than this. Hyperlipidemia is one of the most important risk factors for stroke, and more than 80% of stroke patients have hyperlipidemia. The hyperlipidemia we usually talk about contains two categories: high cholesterol or high triglyceride. Among them, high cholesterol is the culprit of vascular atherosclerosis, especially LDL cholesterol, which is our key indicator for monitoring cardiovascular diseases. The relationship between triglycerides and vascular atherosclerosis has always been controversial. Atherosclerosis is formed due to cholesterol deposition under the inner lining of the arteries, not by the accumulation of triglycerides, and there is no direct link between the two. However, several recent large meta-analyses have shown that high triglycerides can independently increase the risk of cardiovascular events. Therefore, it is now widely recognized in the medical community that triglyceride levels should also be controlled in people at high risk for cardiovascular disease. In conclusion, we need to be clear that there are different types of hyperlipidemia and that it is cholesterol, not triglycerides, that plays a major role in vascular atherosclerosis. We mentioned earlier that deep sea fish oil can lower blood lipids, which has been confirmed by many studies, and its effectiveness is beyond doubt. It mainly reduces triglyceride levels, and actually has little effect on cholesterol, which is closely related to cerebrovascular disease. So, is it necessary for stroke patients to take deep sea fish oil? It is necessary to analyze the specific problems. First of all, to clarify the causes of stroke, stroke has many causes, in addition to vascular atherosclerosis, heart problems, vascular entrapment and vascular inflammation can cause stroke. Only patients with atherosclerotic stroke need strict control of blood lipids; other causes of stroke have little to do with blood lipids. Secondly, it depends on your triglyceride level, we usually consider triglyceride >2.3mmol/L as hypertriglyceridemia, only the existence of hypertriglyceridemia needs intervention, if the triglyceride level is normal, it is not possible to talk about lipid lowering. Finally, depending on current medications, we know that stroke patients usually have hypercholesterolemia, and if hypertriglyceridemia is also present, we call it mixed hyperlipidemia. Regardless of the presence of dyslipidemia, patients with vascular sclerotic stroke need to take statins for a long period of time. The main effect of statins is to lower cholesterol, but also triglycerides, and they also have anti-inflammatory and inhibition of the progression of atherosclerosis, so they are essential drugs for stroke patients. Therefore, under the premise of using statin, most of the patients triglyceride can be reduced to normal level, only a very small number of patients triglyceride is still relatively high. For patients whose triglyceride levels are still relatively high after statin use, lipid-lowering drugs of the beta class and deep-sea fish oil can be used to further reduce blood lipids. This should be further selected according to the level of triglyceride and the economic situation. Biotics are strong and inexpensive, about 5 RMB for a bottle of 100 tablets, but there are certain side effects, which is suitable for patients with significantly elevated triglyceride levels, and is the first-line drug; deep-sea fish oil is weak and expensive, usually costing several hundred RMB for a bottle, but it is safer and has no obvious side effects, which is the second-line drug, and is suitable for patients with mildly elevated triglyceride levels. How to choose, need to combine with the patient’s physical condition individualized analysis. In addition, while taking the drug, you should also pay attention to the adjustment of dietary habits. When it comes to blood lipids, people always think that fat intake has the most to do with blood lipid levels, but it is actually wrong. The closest relationship with triglycerides is sugary foods. Since triglycerides can be synthesized in the liver, its main source is not directly eaten but stimulated to be synthesized by the liver through high-sugar foods. Therefore, reducing the intake of high-sugar foods is the most effective way to reduce triglycerides. After analyzing so much, to summarize, deep sea fish oil can reduce blood fat, safety is better, has certain health effects, but it can not be taken as medicine. For stroke patients, even more can not replace the deep sea fish oil statin drugs, the two roles are different, deep sea fish oil mainly to reduce triglyceride, statin drugs mainly to reduce cholesterol, the latter is the main culprit of vascular atherosclerosis.