Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association
Open accessAbstract
Multiple randomized controlled trials (RCTs) have assessed the effects of supplementation with eicosapentaenoic acid plus docosahexaenoic acid (omega-3 polyunsaturated fatty acids, commonly called fish oils) on the occurrence of clinical cardiovascular diseases. Although the effects of supplementation for the primary prevention of clinical cardiovascular events in the general population have not been examined, RCTs have assessed the role of supplementation in secondary prevention among patients with diabetes mellitus and prediabetes, patients at high risk of cardiovascular disease, and those with prevalent coronary heart disease. In this scientific advisory, we take a clinical approach and focus on common indications for omega-3 polyunsaturated fatty acid supplements related to the prevention of clinical cardiovascular events. We limited the scope of our review to large RCTs of supplementation with major clinical cardiovascular disease end points; meta-analyses were considered secondarily. We discuss the features of available RCTs and provide the rationale for our recommendations. We then use existing American Heart Association criteria to assess the strength of the recommendation and the level of evidence. On the basis of our review of the cumulative evidence from RCTs designed to assess the effect of omega-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events, we update prior recommendations for patients with prevalent coronary heart disease, and we offer recommendations, when data are available, for patients with other clinical indications, including patients with diabetes mellitus and prediabetes and those with high risk of cardiovascular disease, stroke, heart failure, and atrial fibrillation.
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The American Heart Association scientific statements currently recommend n-3 PUFA supplements for secondary prevention of coronary heart disease and in management of hypertriglyceridemia.
“The American Heart Association scientific statements currently recommend n-3 PUFA supplements for secondary prevention of coronary heart disease 15 and in management of hypertriglyceridemia 16 .”
From Effects of n-3 Fatty Acid Supplements in Elderly Patients After Myocardial Infarction (2021) · cites this paper as [15]
Reduction in atherosclerosis in animal models or humans by administration of OM3FAs has not been convincingly demonstrated.
“However, reduction in atherosclerosis in animal models or humans by administration of OM3FAs has not been convincingly demonstrated [8, 11].”
There is a lack of evidence that OM3FA treatment reduces CV events in patients with hypertriglyceridemia of any severity.
“There is a lack of evidence that OM3FA treatment reduces CV events in patients with hypertriglyceridemia of any severity, as recently reviewed by Siscovick and colleagues [8].”
The latest meta-analysis and an American Heart Association statement give modest support for using low-dose fish oil supplements.
“Based on the latest meta-analysis (17) and American Heart Association Scientific Statement (18), there is modest support for their use.”
From Cardiovascular Impact of Nutritional Supplementation With Omega-3 Fatty Acids (2021) · cites this paper as [18]
There is a lack of consistent support for omega-3 dietary supplements in cardiovascular risk reduction.
“Despite extensive interest and research, there is a lack of consistent support for OM-3 dietary supplements in CV risk reduction.”
From Critical Differences Between Dietary Supplement and Prescription Omega-3 Fatty Acids: A Narrative Review (2020) · cites this paper as [23]
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Self-citation
- Authors
- Siscovick, D. S., Barringer, T. A., Fretts, A. M., Wu, J. H. Y., Lichtenstein, A. H., Costello, R. B., Kris-Etherton, P. M., Jacobson, T. A., Engler, M. B., Alger, H. M., Appel, L. J., & Mozaffarian, D.
- ORCID
- Venue
- Circulation
- Published
- 2017-04-11
- Volume
- 135
- Issue
- 15
- Pages
- e867-e884
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC6903779
- OpenAlex
- W2597054569
- Cited by
- 629
- References
- 52
- Citations by year
- 2026: 21 · 2025: 42 · 2024: 57 · 2023: 57 · 2022: 64 · 2021: 66 · 2020: 90 · 2019: 90 · 2018: 100 · 2017: 40 · 2015: 2
- FWCI
- 9.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL101236, R01HL085710)
- 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
- Physical Sciences › Chemistry › Organic Chemistry › Edible Oils Quality and Analysis
- Keywords
- omega-3 polyunsaturated fatty acids, fish oil supplementation, eicosapentaenoic acid, docosahexaenoic acid, cardiovascular disease prevention, secondary prevention, coronary artery disease, diabetes mellitus, prediabetes, high cardiovascular risk, stroke, heart failure, atrial fibrillation
- MeSH terms
- Atrial Fibrillation, Cardiovascular Diseases, Diabetes Mellitus, Fish Oils, Heart Failure, Cardiac Surgical Procedures, Humans, Primary Prevention, Risk, Fatty Acids, Omega-3, Dietary Supplements, Stroke, Diabetes Complications, Secondary Prevention
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