Do Omega-3 Supplements Help Lower the Risk of Heart Disease?

Do omega-3 supplements help lower the risk of heart disease?

Check out this answer from Consensus:

The current body of research suggests that while omega-3 supplements may offer some cardiovascular benefits, particularly in reducing the risk of MACE, cardiovascular death, and MI, their overall impact on mortality and broad cardiovascular events is limited. Higher doses and specific subgroups, such as patients with acute MI or high-risk CHD, may experience more pronounced benefits. However, statins remain more effective in reducing cardiovascular risks compared to omega-3 supplements.

Omega-3 fatty acids, commonly found in fish oil and certain plant oils, have been widely studied for their potential benefits in reducing the risk of cardiovascular diseases (CVD). Despite numerous studies, the effectiveness of omega-3 supplements in preventing heart disease remains a topic of debate.

Key Insights

• Limited Impact on Mortality and Cardiovascular Events:
  • Increasing intake of long-chain omega-3 (LCn3) and alpha-linolenic acid (ALA) shows little to no effect on all-cause mortality, cardiovascular mortality, and cardiovascular events1 2 4.
  • Omega-3 supplementation does not significantly reduce the risk of stroke or arrhythmia1 4.
• Potential Benefits in Specific Conditions:
  • Omega-3 supplementation may slightly reduce the risk of major adverse cardiovascular events (MACE), cardiovascular death, and myocardial infarction (MI)3 6 8.
  • Higher doses of omega-3 (more than 1 gram per day) are more effective in reducing the risk of cardiac death, MACE, and MI8.
• Subgroup Benefits:
  • Patients with acute MI or high-risk CHD may benefit more from omega-3 supplementation, showing reduced incidence of MACE and cardiovascular death3.
  • African Americans may derive greater benefits for MI and recurrent hospitalization for heart failure7.
• Comparative Effectiveness:
  • Statins are generally more effective than omega-3 supplements in reducing the risk of total cardiovascular disease, coronary heart disease, myocardial infarction, and stroke10.
• Dose-Response Relationship:
  • There is a linear dose-response relationship between marine omega-3 dosage and the reduction in total cardiovascular disease and major vascular events6.

 

 

Do omega-3 supplements help lower the risk of heart disease?

Suzanne R Steinbaum has answered Near Certain

An expert from The Mount Sinai Hospital in Cardiology

There are thousands of published scientific studies showing the benefit of Omega-3s, and specifically eicosapentaenoic (EPA) and docosahexaenoic (DHA), on human health. Some of the numerous benefits of Omega-3s include supporting healthy triglyceride levels, healthy arteries, eye health and vision, cognitive health, and healthy skin and joints.

Consuming adequate amounts of Omega-3s – and specifically EPA and DHA – is important to a healthy lifestyle that includes exercising, getting enough sleep, not smoking and having an overall healthy diet. The American Heart Association (AHA) recommends that people eat fish 2-3 times per week. Many people, however, still don’t get the recommended amounts of Omega-3s per day. Supplements aren’t a replacement for a healthy diet, but they can be important when attempting to bridge the gaps in your diet. The reality is, it is difficult to consume enough of these nutrients through food alone. Being educated on the supplements one might take is extremely important and in many cases overlooked.

 

Do omega-3 supplements help lower the risk of heart disease?

G Ed Rainger has answered Near Certain

An expert from Birmingham University in Cardiovascular Disease, Immunology

Epidemiology is quite clear, with meta-analysis showing significant benefit in primary and secondary prevention of myocardial infarction. This picture has been somewhat confused by recent trials (last 10 years). However, the more recent trials showing no signal for benefit of n3 supplementation are compromised by extremely small numbers of participants, unrealistically low levels of supplementation, or both. Trials involving many thousands of participants have shown beneficial effects and in some competition studies with pharmacological interventions, n-3 PUFAS have shown effects on a par with intervention with statins, with combination therapies showing a larger signal than either intervention alone. In my opinion they are protective, but mechanism of action is still extremely poorly defined.

 

Do omega-3 supplements help lower the risk of heart disease?

Aleix Sala-Vila has answered Likely

An expert from The August Pi i Sunyer Biomedical Research Institute in Nutrition

Yes, but…

1.  The highest degree of scientific evidence is attained through randomized controlled trials.
2. Regarding omega-3 supplements, these trials are limited to secondary prevention, in other words prevention of recurrence of cardiovascular events (e.g. a second heart attack, or heart failure) in patients already diagnosed with a heart attack. Recent large trials provided mixed results, questioning the long-believed protective effects of omega-3 supplements. The presumed benefits of omega-3 are likely masked by the current universal statin treatment after the first heart attack, and by the fact that, in contrast to participants from early trials, these subjects are no longer deficient in omega-3. However, the American Heart Association states that “even a potential modest reduction in coronary heart disease mortality in this population would justify treatment with a relatively safe therapy. We now recommend treatment for patients with prevalent heart failure without preserved left ventricular function to reduce mortality and hospitalizations on the basis of a single, large randomized controlled trial.” (Siscovick and co-workers, Circulation, 2017).
3. To date, there are no available data on randomized controlled trials on omega-3 supplements and primary prevention of coronary heart disease (in other words preventing the first heart attack). Therefore, no recommendations on supplements can be made based on clinical trials. However, based on large epidemiologic studies, the International Society for the Study of Fatty Acids and Lipids recommended in 2004 an intake of at least 500 mg/d of fish-derived omega-3 for primary cardiovascular prevention (http://www.issfal.org/statements/pufa-recommendations/statement-3). In absence of fish oil supplementation, this goal can be achieved by meeting the American Heart Association recommendations to consume at 1-2 servings per week of fish, preferably fatty fish (Rimm and co-workers, Circulation, 2018).

 

Do omega-3 supplements help lower the risk of heart disease?

George E Billman has answered Unlikely

An expert from Ohio State University in Cardiovascular Disease

Probably not for most individuals:

Despite a strong association between fish consumption and a reduced incidence of adverse cardiovascular events and mortality, that was first reported in the 1970’s, clinical trials that investigated the effects omega-3 fatty acids (supplements) on these cardiovascular events have largely failed to confirm this initial observation. Specifically, a recent meta-analysis of 79 random placebo-control clinical trials with 112,059 patients concluded that “increasing EPA and DHA had little or no effect on mortality or cardiovascular health” (Abdelhamid et al., Cochrane Database Systematic Reviews 2018 doi:10.1002/14651858.CD003177.pub3).  These authors also failed to detect any dose-dependent benefits.  Again despite some exciting preliminary reports, omega-3 fatty acids supplements failed to prevent potentially life-threatening changes in the heart rhythm, known as cardiac arrhythmias.  Indeed, some limited data from animal studies indicate that these fatty acids could actually make these arrhythmias worse under certain conditions, such as during a heart attack (myocardial ischemia). However, it should be noted that high concentrations of a relatively pure pharmaceutical grade EPA supplements (that is, prescription only as opposed to over the counter preparations) may have both reduced blood triglyceride levels and adverse cardiovascular events in a very high risk group of patients (diabetic patients with elevated triglycerides levels). It must be empathized that these results are only available in a press release from the study sponsor. A complete evaluation of these very promising findings can only be made once the full details have been published in a peer-reviewed scientific journal.

So what is the bottom line: do omega-3 fatty acids supplements reduce the risk for adverse cardiovascular events?  The answer may depend on the both the patient population studied and the dose used. In high risk patients with abnormally high blood triglycerides, perhaps a high dose of purified EPA can protect against adverse cardiovascular events. However, for most individuals, over-the-counter omega-3 fatty acid supplements provide very little cardiovascular benefit. The greatest benefits accrue from living a healthy life style: don’t use tobacco, enjoy regular moderate exercise (a brisk 30 minutes of walking at least 3 times a week week), eat a heart healthy diet (low in saturated fat), and maintain a normal blood pressure.

 

Do omega-3 supplements help lower the risk of heart disease?

Peter  McCaffery has answered Uncertain

An expert from University of Aberdeen in Biochemistry

This is not an easy one as there is a confusing mix of both positive and negative trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153275/

Certainly there seem to be a series of positive effects https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357022/ but there is a real worry that in some cases it can interfere with normal heart rhythm – something called atrial fibrillation https://academic.oup.com/ehjcvp/advance-article/doi/10.1093/ehjcvp/pvab008/6255232

 

Do omega-3 supplements help lower the risk of heart disease?

William S Harris has answered Near Certain

An expert from University of South Dakota in Nutrition

40 years of research on omega-3 EPA and DHA has largely supported the cardiovascular benefits of these marine-derived nutrients. While there have been several failed RCTs with omega-3, the reason is likely to be insufficient dose, but even in some studies with “low” doses of EPA+DHA (e.g. ASCEND, where 840 mg/d reduced risk for vascular death in diabetic subjects by 18%). More evidence that it is probably a dose problem comes from the recently-reported REDUCE-IT study. In this RCT with over 8000 patients, all on statins but with slightly elevated triglyceride levels, the omega-3 pharmaceutical agent called Vascepa (Amarin Corp, which is essentially pure EPA ethyl esters) at a dose of 4 g/d reduced (according to a recent press release) major adverse cardiac events by 25% vs placebo. (Full paper to be published on Nov 10). So, yes, if the dose is high enough to raise average blood (RBC) EPA+DHA levels (aka the Omega-3 Index) to levels >8%, then benefit is “almost certain.”

 

Do omega-3 supplements help lower the risk of heart disease?

Yutaka J Matsuoka has answered Likely

An expert from National Cancer Center Japan in Psychiatry, Epidemiology

It is very easy to miss the small signals of therapeutic efficacy in placebo-controlled clinical trials and/or meta-analytic reviews without careful considerations on study designs. For example, the ASCEND Study Collaborative Group published a recent paper in New England Journal of Medicine, showing that the cardiac protection effects of omega-3 fatty acid supplements are not detectable. However, the Omega-3 Index levels were “extremely” high (7.1%) in their subjects. That level of average Omega-3 Index concentration is already considered to be cardioprotective.

 

Do omega-3 supplements help lower the risk of heart disease?

Carol  Haggans has answered Unlikely

An expert from National Institutes of Health in Nutrition, Dietetics

Consuming fish and other seafood as part of a balanced diet promotes heart health, but the evidence for omega-3 supplements is less clear. Omega-3 supplements do lower triglyceride levels and they might have some benefits for the heart, especially among people with lower dietary omega-3 intakes. But the results of several big clinical trials did not find that omega-3 supplements reduce the risk of cardiovascular events, stroke, arrhythmia, or death from any cause.

 

Do omega-3 supplements help lower the risk of heart disease?

Mariasole Da Boit has answered Unlikely

An expert from De Montfort University (DMU) in Health, Nutrition, Exercise Physiology

In the past numerous studies have shown that Omega-3 supplementation may help in the prevention or treatment of many diseases such as cardiovascular disease. However, in recent years, these findings have been challenged by other studies reporting no benefits of Omega-3 supplementation on cardiovascular health. Particularly, recent meta-analysis have failed to prove any associations between Omega-3 supplementation and improvements in cardiovascular diseases, concluding that previous findings derived from trials with higher risk of bias.

 

Do omega-3 supplements help lower the risk of heart disease?

Iwona Rudkowska has answered Near Certain

An expert from Quebec University Hospital Laval in Nutrition

Numerous epidemiological, observational, and randomized controlled trials have established the positive cardiovascular effects of omega-3 supplements. The mechanisms by which omega-3 supplements reduce cardiovascular risk are various. Potential mechanisms include antiarrhythmic effects, anti-thrombotic effects, anti-inflammatory effects, lowered blood pressure, improved endothelial function, hypotriglyceridemic effects in hypertriglyceridemic individuals and retarded growth of atherosclerotic plaque.   However, there is variability in response to omega-3 supplementation between individuals on CVD risk factors (for example hypotriglyceridemic effects); yet, most individuals will have some beneficial effects of omega-3 supplementation on cardiovascular risk factors.

 

Do omega-3 supplements help lower the risk of heart disease?

Guy Rousseau has answered Likely

An expert from Université de Montréal in Cardiovascular Disease

If you have a good diet, the supplement should not be necessary. However, if you only add omega-3 without changing the level of omega-6 in your diet, the effect of omega-3 should be very tiny. The effect of omega-3 by itself should be good but other constituents of the diet may influence the result. It would be better to change your diet instead of adding supplements.

 

Do omega-3 supplements help lower the risk of heart disease?

Angela M Shysh has answered Likely

An expert from Bogomoletz Institute of Physiology in Molecular Biology

Consumption of omega-3 polyunsaturated fatty acids (PUFA) has long been known to reduce the incidence of cardiovascular disease and decrease the risk for heart failure. A large body of evidence has demonstrated that omega-3 PUFA protect the myocardium against ischemia-reperfusion injury. It is important to note that sudden cardiac death presumably due to ventricular fibrillation can occur as a first manifestation of heart disease, while omega-3 PUFA reduce cardiovascular diseases and the incidence of sudden arrhythmic death in clinical as well as experimental setting.  Omega-3 PUFA administration has accelerated recover of post-ischemic dysfunctions in hearts and decreased necrotic and apoptotic death of cardiomyocytes in culture at anoxia-reoxygenation modeling. Omega-3 PUFAs prevents the development of oxidative stress and dietary supplementation of omega-3 PUFAs decreases the risk of cardiovascular disease.

 

Do omega-3 supplements help lower the risk of heart disease?

H Murff has answered Near Certain

An expert from Vanderbilt University in Nutrition

There is strong clinical evidence to support the beneficial effects of omega-3 supplements on cardiovascular outcomes however clinical trials results have been mixed, with beneficial effects or null effects. It is likely there may be specific factors that influence whether someone derives a significant benefit from omega-3.  A very large recent clinical trial suggests individuals who have there LDL cholesterol controlled on statins but high triglycerides might have the most benefit from treatment. Factors such as dose, EPA versus DHA, background diet, and genetics might also impact response. Nevertheless, there are groups that are very likely to benefit from omega-3 supplemenation.