Skip to main content

Advertisement

Log in

Omega-3 Fatty Acids for Cardiovascular Disease Prevention

  • Prevention
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Major dietary sources of omega-3 fatty acids are fish containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as well as nuts, seeds, and vegetable oils containing α-linolenic acid (ALA). Omega-3 fatty acids, especially those derived from marine sources, may be a useful tool for the primary and secondary prevention of cardiovascular disease. Omega-3s exert their cardioprotective effects through multiple mechanisms, including reducing arrhythmias and altering production of prostaglandins, which reduces inflammation and improves platelet and endothelial function. To date, no serious adverse effects of omega-3s have been identified, despite extensive study. In adults, any potential harm from mercury exposure from consuming fish rich in omega-3s is outweighed by the proven cardiovascular benefits of eating fish. Concerns over increased bleeding complications have not materialized despite the increased concomitant use of aspirin and clopidogrel. We recommend one serving (200–400 g) of fatty fish two times per week and a diet that includes foods rich in ALA for the primary prevention of cardiovascular disease. We recommend one serving (200–400 g) of fatty fish or a fish oil supplement containing 900 mg of EPA + DHA every day and a diet rich in ALA for patients with known cardiovascular disease or congestive heart failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Dyerberg J, Bang HO, Stoffersen E, et al.: Eicosapentaenoic acid and prevention of thrombosis and atherosclerosis? Lancet 1978, 2(8081):117–119.

    Article  CAS  PubMed  Google Scholar 

  2. Albert CM, Campos H, Stampfer MJ, et al.: Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002, 346(15):1113–1118.

    Article  CAS  PubMed  Google Scholar 

  3. Albert CM, Hennekens CH, O’Donnell CJ, et al.: Fish consumption and risk of sudden cardiac death. JAMA 1998, 279(1):23–28.

    Article  CAS  PubMed  Google Scholar 

  4. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet 1999, 354(9177):447–455 [Published erratum appears in Lancet 2001, 357(9256):642].

  5. Ascherio A, Rimm EB, Stampfer MJ, et al.: Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men. N Engl J Med 1995, 332(15):977–982.

    Article  CAS  PubMed  Google Scholar 

  6. DeFilippis AP, Sperling LS: Understanding omega-3’s. Am Heart J 2006, 151(3):564–570.

    Article  CAS  PubMed  Google Scholar 

  7. Kris-Etherton PM, Harris WS, Appel LJ, American Heart Association: Nutrition C: Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002, 106(21):2747–2757 [Published erratum appears in Circulation 2003, 107(3):512].

    Article  PubMed  Google Scholar 

  8. Kromhout D, Bosschieter EB, de Lezenne Coulander C: The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med 1985, 312(19):1205–1209.

    Article  CAS  PubMed  Google Scholar 

  9. Yokoyama M, Origasa H, Matsuzaki M, et al.; Japan EPA lipid intervention study (JELIS) Investigators: Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007, 369(9567):1090–1098.

    Article  CAS  PubMed  Google Scholar 

  10. Lev ES, Harel A, Mager N, et al.: Treatment of aspirin-resistant patients with omega-3 fatty acids versus aspirin dose escalation. J Am Coll Cardiol 2010, 55(2):114.

    Article  CAS  PubMed  Google Scholar 

  11. Farzaneh-Far R, Harris WS, Garg S, et al.: Inverse association of erythrocyte n-3 fatty acid levels with inflammatory biomarkers in patients with stable coronary artery disease: The Heart and Soul Study. Atherosclerosis 2009, 205(2):538–543.

    Article  CAS  PubMed  Google Scholar 

  12. Farzaneh-Far R, Lin J, Epel ES, et al.: Association of marine omega-3 fatty acid levels with telomeric aging in patients with coronary heart disease. JAMA 303(3):250–257

  13. He K, Liu K, Daviglus ML, et al.: Associations of dietary long-chain n-3 polyunsaturated fatty acids and fish with biomarkers of inflammation and endothelial activation (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2009, 103(9):1238–1243.

    Article  CAS  PubMed  Google Scholar 

  14. Lopez-Garcia E, Schulze MB, Manson JE, et al.: Consumption of (n-3) fatty acids is related to plasma biomarkers of inflammation and endothelial activation in women. J Nutr 2004, 134(7):1806–1811.

    CAS  PubMed  Google Scholar 

  15. Micallef MA, Munro IA, Garg ML: An inverse relationship between plasma n-3 fatty acids and C-reactive protein in healthy individuals. Eur J Clin Nutr 2009, 63(9):1154–1156.

    Article  CAS  PubMed  Google Scholar 

  16. Pischon T, Hankinson SE, Hotamisligil GS, et al.: Habitual dietary intake of n-3 and n-6 fatty acids in relation to inflammatory markers among US men and women. Circulation 2003, 108(2):155–160.

    Article  CAS  PubMed  Google Scholar 

  17. Kris-Etherton PM, Grieger JA, Etherton TD: Dietary reference intakes for DHA and EPA. Prostaglandins Leukot Essent Fat Acids 2009, 81(2–3):99–104.

    Article  CAS  Google Scholar 

  18. Lavie CJ, Milani RV, Mehra MR, Ventura HO: Omega-3 polyunsaturated fatty acids and cardiovascular diseases. J Am Coll Cardiol 2009, 54(7):585–594.

    Article  CAS  PubMed  Google Scholar 

  19. Mozaffarian D: Fish, mercury, selenium and cardiovascular risk: current evidence and unanswered questions. Int J Environ Res Public Health 2009, 6(6):1894–1916.

    Article  CAS  PubMed  Google Scholar 

  20. Rawn DF, Breakell K, Verigin V, et al.: Persistent organic pollutants in fish oil supplements on the Canadian market: polychlorinated biphenyls and organochlorine insecticides. J Food Sci 2009, 74(1):T14–T19.

    Article  CAS  PubMed  Google Scholar 

  21. Burdge G: Alpha-linolenic acid metabolism in men and women: nutritional and biological implications. Curr Opin Clin Nutr Metab Care 2004, 7(2):137–144.

    Article  CAS  PubMed  Google Scholar 

  22. DeFilippis AP, Harper CR, Cotsonis GA, Jacobson TA: Effect of baseline plasma fatty acids on eicosapentaenoic acid levels in individuals supplemented with alpha-linolenic acid. Int J Food Sci Nutr 2009, 60(Suppl 5):28–37.

    Article  CAS  PubMed  Google Scholar 

  23. Emken EA, Adlof RO, Gulley RM: Dietary linoleic acid influences desaturation and acylation of deuterium-labeled linoleic and linolenic acids in young adult males. Biochim Biophys Acta 1994, 1213(3):277–288.

    CAS  PubMed  Google Scholar 

  24. Gerster H: Can adults adequately convert alpha-linolenic acid (18:3n-3) to eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3)? Int J Vitam Nutr Res 1998, 68(3):159–173.

    CAS  PubMed  Google Scholar 

  25. Goyens PL, Spilker ME, Zock PL, et al.: Conversion of alpha-linolenic acid in humans is influenced by the absolute amounts of alpha-linolenic acid and linoleic acid in the diet and not by their ratio. Am J Clin Nutr 2006, 84(1):44–53.

    CAS  PubMed  Google Scholar 

  26. Harper CR, Edwards MJ, DeFilipis AP, Jacobson TA: Flaxseed oil increases the plasma concentrations of cardioprotective (n-3) fatty acids in humans. J Nutr 2006, 136(1):83–87.

    CAS  PubMed  Google Scholar 

  27. Layne KS, Goh YK, Jumpsen JA, et al.: Normal subjects consuming physiological levels of 18:3(n-3) and 20:5(n-3) from flaxseed or fish oils have characteristic differences in plasma lipid and lipoprotein fatty acid levels. J Nutr 1996, 126(9):2130–2140.

    CAS  PubMed  Google Scholar 

  28. Sprecher H: An update on the pathways of polyunsaturated fatty acid metabolism. Curr Opin Clin Nutr Metab Care 1999, 2(2):135–138.

    Article  CAS  PubMed  Google Scholar 

  29. Mozaffarian D, Ascherio A, Hu FB, et al.: Interplay between different polyunsaturated fatty acids and risk of coronary heart disease in men. Circulation 2005, 111(2):157–164.

    Article  CAS  PubMed  Google Scholar 

  30. US Department of Health and Human Services Agency for Healthcare Research and Quality: Effects of omega-3 fatty acids on cardiovascular risk factors and intermediate markers of cardiovascular disease. Evidence Report/Technology Assessment (Summary): Number 93. Available at http://www.ahrq.gov/clinic/epcsums/o3cardrisksum.htm2004. Accessed May 2010.

  31. Weber PC: Clinical studies on the effects of n-3 fatty acids on cells and eicosanoids in the cardiovascular system. J Intern Med Suppl 1989, 225(731):61–68.

    Google Scholar 

  32. Weber PC, Leaf A: Cardiovascular effects of omega 3 fatty acids. Atherosclerosis risk factor modification by omega 3 fatty acids. World Rev Nutr Diet 1991, 66:218–232.

    CAS  PubMed  Google Scholar 

  33. Simopoulos AP: Essential fatty acids in health and chronic disease. Am J Clin Nutr 1999, 70(3 Suppl):560S–569S.

    CAS  PubMed  Google Scholar 

  34. Ross R: Atherosclerosis—an inflammatory disease. N Engl J Med 1999, 340(2):115–126.

    Article  CAS  PubMed  Google Scholar 

  35. Ridker PM, Hennekens CH, Buring JE, Rifai N: C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000, 342(12):836–843.

    Article  CAS  PubMed  Google Scholar 

  36. Patrono C: The PGH-synthase system and isozyme-selective inhibition. J Cardiovasc Pharmacol 2006, 47(Suppl 1):S1–S6.

    Article  CAS  PubMed  Google Scholar 

  37. Patrono C, Falco A, Davi G: Isoprostane formation and inhibition in atherothrombosis. Curr Opin Pharmacol 2005, 5(2):198–203.

    Article  CAS  PubMed  Google Scholar 

  38. Needleman P, Raz A, Minkes MS, et al.: Triene prostaglandins: prostacyclin and thromboxane biosynthesis and unique biological properties. Proc Natl Acad Sci U S A 1979, 76(2):944–948.

    Article  CAS  PubMed  Google Scholar 

  39. Engstrom K, Wallin R, Saldeen T: Effect of low-dose aspirin in combination with stable fish oil on whole blood production of eicosanoids. Prostaglandins Leukot Essent Fat Acids 2001, 64(6):291–297.

    Article  CAS  Google Scholar 

  40. Kramer HJ, Stevens J, Grimminger F, Seeger W: Fish oil fatty acids and human platelets: dose-dependent decrease in dienoic and increase in trienoic thromboxane generation. Biochem Pharmacol 1996, 52(8):1211–1217.

    Article  CAS  PubMed  Google Scholar 

  41. Calo L, Bianconi L, Colivicchi F, et al.: N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. J Am Coll Cardiol 2005, 45(10):1723–1728.

    Article  CAS  PubMed  Google Scholar 

  42. Reiffel JA, McDonald A: Antiarrhythmic effects of omega-3 fatty acids. Am J Cardiol 2006, 98(4A):50i–60i.

    Article  CAS  PubMed  Google Scholar 

  43. Senges S: Randomized trial of omega-3 fatty acids on top of modern therapy after acute myocardial infarction: the OMEGA trial. Presented at the American College of Cardiology 58th Annual Scientific Session. Orlando, FL: March 29–31, 2009.

  44. Tavazzi L, Maggioni AP, Marchioli R, et al.: Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 2008, 372(9645):1223–1230.

    Article  PubMed  CAS  Google Scholar 

  45. Brouwer IA, Raitt MH, Dullemeijer C, et al.: Effect of fish oil on ventricular tachyarrhythmia in three studies in patients with implantable cardioverter defibrillators. Eur Heart J 2009, 30(7):820–826.

    Article  CAS  PubMed  Google Scholar 

  46. Mozaffarian D, Rimm EB: Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA 2006, 296(15):1885–1899.

    Article  CAS  PubMed  Google Scholar 

  47. Virtanen JK, Mursu J, Voutilainen S, Tuomainen TP: Serum long-chain n-3 polyunsaturated fatty acids and risk of hospital diagnosis of atrial fibrillation in men. Circulation 2009, 120(23):2315–2321.

    Article  CAS  PubMed  Google Scholar 

  48. Macchia A, Varini S, Grancelli H, et al.: The rationale and design of the FORomegaARD Trial: a randomized, double-blind, placebo-controlled, independent study to test the efficacy of n-3 PUFA for the maintenance of normal sinus rhythm in patients with previous atrial fibrillation. Am Heart J 2009, 157(3):423–427.

    Article  CAS  PubMed  Google Scholar 

  49. Pratt CM, Reiffel JA, Ellenbogen KA, et al.: Efficacy and safety of prescription omega-3-acid ethyl esters for the prevention of recurrent symptomatic atrial fibrillation: a prospective study. Am Heart J 2009, 158(2):163–169.e161–163.

    Google Scholar 

  50. US Department of Health and Human Services Agency for Healthcare Research and Quality: Effects of omega-3 fatty acids on cardiovascular disease. Evidence Report/Technology Assessment: Number 94. Available at http://www.ahrq.gov/downloads/pub/evidence/pdf/o3cardio/o3cardio.pdf. Accessed May 2010.

  51. US Food and Drug Administration: Center for Food Safety and Applied Nutrition. Washington, DC: Department of Health and Human Services; 2004.

  52. Watson PD, Joy PS, Nkonde C, et al.: Comparison of bleeding complications with omega-3 fatty acids + aspirin + clopidogrel—versus—aspirin + clopidogrel in patients with cardiovascular disease. Am J Cardiol 2009, 104(8):1052–1054.

    Article  CAS  PubMed  Google Scholar 

  53. Hites RA, Foran JA, Carpenter DO, et al.: Global assessment of organic contaminants in farmed salmon. Science 2004, 303(5655):226–229.

    Article  CAS  PubMed  Google Scholar 

  54. Foran SE, Flood JG, Lewandrowski KB: Measurement of mercury levels in concentrated over-the-counter fish oil preparations: is fish oil healthier than fish? Arch Pathol Lab Med 2003, 127(12):1603–1605.

    CAS  PubMed  Google Scholar 

  55. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002, 106(25):3143–3421.

    Google Scholar 

  56. Bays HE, McKenney J, Maki KC, et al.: Effects of prescription omega-3-acid ethyl esters on non–high-density lipoprotein cholesterol when coadministered with escalating doses of atorvastatin. Mayo Clin Proc 2010, 85(2):122–128.

    Article  CAS  PubMed  Google Scholar 

  57. Davidson MH, Stein EA, Bays HE, et al.: Efficacy and tolerability of adding prescription omega-3 fatty acids 4 g/d to simvastatin 40 mg/d in hypertriglyceridemic patients: an 8-week, randomized, double-blind, placebo-controlled study. Clin Ther 2007, 29(7):1354–1367.

    Article  CAS  PubMed  Google Scholar 

  58. American Heart Association: Methodology Manual for ACC/AHA Guideline Writing Committees: Methodologies and Policies from the ACC/AHA Task Force on Practice Guidelines. Available at http://www.acc.org/qualityandscience/clinical/manual/pdfs/methodology.pdf and http://circ.ahajournals.org/manual/. Accessed February 16, 2010.

Download references

Acknowledgment

Dr. DeFilippis is supported by a National Research Service Award (NRSA) Training Grant (T32-HL-07227).

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew Paul DeFilippis MD, MSc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

DeFilippis, A.P., Blaha, M.J. & Jacobson, T.A. Omega-3 Fatty Acids for Cardiovascular Disease Prevention. Curr Treat Options Cardio Med 12, 365–380 (2010). https://doi.org/10.1007/s11936-010-0079-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-010-0079-4

Keywords

Navigation