“Effect of omega-3 fatty acids combined with tocotrienol and vitamin D3, with or without statin therapy, on lipid profile in patients with hypertriglyceridemia: a prospective comparative study” by Mitra et al.

evaluating the effects of omega-3 fatty acids combined with tocotrienol and vitamin D3 in patients with hypertriglyceridemia receiving or not receiving statin therapy.The authors should be congratulated for addressing an important clinical issue related to residual hypertriglyceridemia and for presenting data from a relatively large real-world cohort.However, we would like to raise several concerns regarding the interpretation of the findings.First, the principal conclusion of the study is based on the observation that triglyceride reduction was greater in patients not receiving statins than in those receiving concomitant statin therapy.The authors suggest several potential explanations, including a possible pharmacodynamic interaction or a "ceiling effect" associated with statin treatment.In our opinion, these interpretations are not supported by the study design.Because treatment allocation was nonrandomized and determined at the physician's discretion, the two groups may have differed in numerous unmeasured clinical characteristics despite apparently similar baseline variables.Residual confounding therefore remains highly likely and precludes any mechanistic conclusions regarding the interaction between statins and the nutraceutical combination.Second, the observed finding appears biologically counterintuitive.Statins are known to improve triglyceride metabolism and are routinely combined with https://journals.