Recent research indicates that in diets high in monounsaturated fatty acids, a combination of plant sterols and fish oils better support cardiovascular health than fish oils alone. EPA and DHA decrease the breakdown of triglycerides in fat cells, while increasing their breakdown in the heart and skeletal muscle. Fish oils cause adipose tissue to take up these fatty acids, and decrease their delivery to the liver. This prevents their incorporation into very low density lipoproteins (VLDL molecules which transport lipids from the liver to other parts of the body), and leads to decreased VLDL production. β-oxidation of fatty acids in the liver, fat, heart and skeletal muscle is also increased. This converts fatty acids into acetyl-CoA for energy production in the Krebs cycle and decreases the amount of fatty acids available for the synthesis of triglycerides. Genes that regulate triglyceride synthesis, storage, and β-oxidation are also affected by plant sterols. In randomized, placebo controlled trials, daily supplementation with 1.3-1.4 g of EPA and DHA in combination with plant sterols for 3-4 weeks significantly lowered serum triglycerides by approximately 14-25% in hyperlipidemic adults.