Role of omega-3 fatty acids in heart disease: a comprehensive review

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Omega-3 fatty acids, notably found in fatty fish, have been the subject of extensive research due to their potential health benefits, particularly for heart disease.

This review aims to summarize the current understanding of how omega-3 fatty acids might influence heart health, drawing from key research studies in this field.

What Are Omega-3 Fatty Acids?

Before we delve into the heart-specific effects, it’s important to understand what omega-3 fatty acids are. They’re a type of fat that our bodies can’t make, so we have to get them from our diet.

There are three types of omega-3s: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).

ALA comes from plant sources like flaxseed, while EPA and DHA are found in fish and other seafood.

Omega-3 and Heart Health: The Hypothesis

The link between omega-3 fatty acids and heart health was first observed in populations with high fish consumption, such as the Inuit and Japanese, who had lower rates of heart disease despite a high-fat diet.

This led scientists to hypothesize that omega-3 fatty acids might have protective effects against heart disease.

Research Evidence: Clinical Trials and Observational Studies

Several major clinical trials have been conducted to examine this hypothesis.

One such trial, the GISSI-Prevenzione trial, found that heart attack survivors who took a supplement with EPA and DHA had a lower risk of death, heart attack, and stroke.

In another study, the JELIS trial in Japan, patients with high cholesterol who were given EPA supplements had a lower risk of major coronary events, particularly if they had a history of coronary artery disease.

In contrast, the more recent STRENGTH and REDUCE-IT trials, which examined high-dose omega-3 supplements, showed mixed results.

The REDUCE-IT trial reported a reduced risk of cardiovascular events with high-dose EPA, but the STRENGTH trial found no significant benefit with a combination of high-dose EPA and DHA.

Observational studies, which follow large groups of people over time, also show a consistent link between higher omega-3 intake and lower risk of heart disease.

However, these studies can’t prove cause and effect, only an association.

Mechanism of Action: How Might Omega-3s Benefit the Heart?

Omega-3 fatty acids are believed to improve heart health through several mechanisms.

They have anti-inflammatory properties, reduce triglycerides, lower blood pressure, improve blood vessel function, and make blood less likely to clot, which can lead to heart attack and stroke.

Omega-3s may also reduce heart rate and increase heart rate variability, which can reduce the risk of sudden death from heart rhythm disturbances.

Practical Implications: Dietary Intake vs. Supplements

The American Heart Association currently recommends eating at least two servings of fatty fish a week and considering omega-3 supplements for people with heart disease who don’t eat enough fish.

However, given the mixed results of recent trials, the role of omega-3 supplements in heart disease prevention is still under debate.

It’s also important to consider the potential risks of excessive omega-3 intake, such as bleeding or the impact on other nutrients, as well as the sustainability of fishing practices.


Overall, the current body of research supports the beneficial role of omega-3 fatty acids in heart health, particularly through dietary sources like fatty fish.

Omega-3 supplements may also have a role in managing heart disease, but more research is needed to fully understand their effects, optimal dosages, and which patients might benefit the most.

In the meantime, a diet rich in omega-3s remains a key component of a heart-healthy lifestyle.

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