The Omega-3 Index and relative risk for coronary heart disease mortality: estimation from 10 cohort studies
Abstract
Background and aims A recent 19-cohort meta-analysis examined the relationships between biomarkers of omega-3 fatty acids and risk for coronary heart disease (CHD). That study did not, however, report hazard ratios (HRs) specifically as a function of erythrocyte eicosapentaenoic (EPA) plus docosahexaenoic (DHA) levels, a metric called the Omega-3 Index in which EPA + DHA content is expressed as a percent of total fatty acids. The Omega-3 Index has been used in several recent studies and is a validated biomarker of omega-3 fatty acid tissue levels, but additional data are needed to confirm (or refute) the originally-proposed clinical cut-points of Methods The present study was therefore undertaken using published data from this meta-analysis to estimate HRs per 1-SD increase in the Omega-3 Index and median quintile values for this metric across 10 of the cohorts for which the needed data were available. Results The overall mean (SD) for the Omega-3 Index in these 10 cohort studies was 6.1% (2.1%), and the HR for a 1-SD increase was 0.85 (95% confidence interval, 0.80-0.91). Median quintile 1 and 5 levels were 4.2% vs. 8.3%, respectively. Based on these values, we estimate that risk for fatal CHD would have been reduced by about 30% moving from an Omega-3 Index of 4%-8%. Conclusions These findings support the use of 8% as reasonable therapeutic targets for the Omega-3 Index.
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Observational studies consistently show that an O3I of ≥8% is ideal for reducing risk of major adverse cardiovascular events, stroke, and all-cause mortality.
“Observational studies consistently show that an O3I of ≥8% is ideal for reducing risk of major adverse cardiovascular events116 (MACE), stroke20 and all-cause mortality117.”
From Effects of Omega-3 Fatty Acid Treatment on Risk for Atrial Fibrillation: An Updated Meta-Analysis of 35 Trials including 114 592 Individuals (2026) · cites this paper as [116]
Higher levels of omega-3 biomarkers are associated with lower risk for ASCVD, Alzheimer's disease, total dementia, heart failure, diabetes, suicidal ideation/self-harm, poor lung function, colorectal cancer, several other malignancies, atopic dermatitis, hospitalization for sepsis, liver cirrhosis, chronic kidney disease, frailty, and hip fractures.
“Other biomarker-based studies have found higher levels of omega-3s to be associated with lower risk for ASCVD116, Alzheimer’s disease130 and total dementia130, heart failure131, diabetes132, suicidal ideation/self-harm133, poor lung function134, colorectal cancer135 and several other malignancies136, atopic dermatitis137, hospitalization for sepsis138, liver cirrhosis139, chronic kidney disease140”
From Effects of Omega-3 Fatty Acid Treatment on Risk for Atrial Fibrillation: An Updated Meta-Analysis of 35 Trials including 114 592 Individuals (2026) · cites this paper as [116]
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- Authors
- Harris, W. S., Del Gobbo, L., & Tintle, N. L.
- Affiliations
- University of South Dakota (US)
- Dordt University (US)
- Corresponding author
- Harris, William S.
- Venue
- Atherosclerosis
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 262
- Pages
- 51-54
- ISSN
- 0021-9150 (ISSN-L)
- OpenAlex
- W2611630545
- Cited by
- 183
- References
- 52
- Citations by year
- 2026: 16 · 2025: 11 · 2024: 19 · 2023: 16 · 2022: 21 · 2021: 21 · 2020: 21 · 2019: 31 · 2018: 23 · 2017: 3 · 2014: 1
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Atherosclerosis (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Agricultural and Biological Sciences › Aquatic Science › Aquaculture Nutrition and Growth
- Keywords
- omega-3 index, coronary heart disease mortality, eicosapentaenoic acid, docosahexaenoic acid, omega-3 fatty acids, hazard ratio, therapeutic target, biomarkers
- MeSH terms
- Diet, Healthy, Coronary Disease, Docosahexaenoic Acids, Erythrocytes, Humans, Prognosis, Risk Factors, Time Factors, Eicosapentaenoic Acid, Cohort Studies, Biomarkers, Risk Assessment, Protective Factors
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