Sea Change for Marine Omega-3s

Abstract

Recently, 3 large randomized controlled trials (RCTs) have assessed the effects of supplementation with marine omega-3 fatty acids on the occurrence of cardiovascular disease (CVD) events. We reviewed this evidence and considered it in the context of the large and growing body of data on the CV health effects of marine omega-3s. One RCT examining 8179 patients, most with coronary heart disease (CHD), reported that 4 grams/day of a highly purified omega-3 product containing eicosapentaenoic acid (EPA) reduced the risk for major adverse CV events by 25% (P<.001). Two other recent RCTs in primary prevention populations showed that approximately 1 gram/day of purified fish oil containing 840 mg/day of EPA and docosahexaenoic acid (DHA) significantly reduced risks of CHD and CV death, especially in individuals who did not consume fish and seafood frequently. The American Heart Association (AHA) continues to emphasize the importance of marine omega-3s as a nutrient for potentially reducing risks of congestive heart failure, CHD, ischemic stroke, and sudden cardiac death. Marine omega-3s should be used in high doses for patients with CHD on statins who have elevated triglycerides and at about 1 gram/day for primary prevention for individuals who do not consume at least 1.5 fish or seafood meals per week.

Requisite Omega-3 HUFA Biomarker Thresholds for Preventing Murine Lupus Flaring

“…A recently published large scale RCT showing positive results with EPA supplementation met many of the suggestions put forth by Rice et al (87): (i) the EPA dose given (4 g/day) was ∼4-fold greater than other contemporaneous trials, (ii) the study had an average duration of 4.9 years, (iii) the baseline EPA levels were identical between the placebo and treatment group, and (iv) the plasma EPA content at 1 year was 5-fold higher than at baseline (90). This study, as well as other recent RCTs showing beneficial effects of ω-3 supplementation have been reviewed in detail by O'Keefe et al (91).…”

Plasma fatty acids and the risk of vascular disease and mortality outcomes in individuals with type 2 diabetes: results from the ADVANCE study

“…In contrast to generally consistent results from observational studies of circulating n-3 fatty acids and DHA, the effects of n-3 fatty acid supplementation on cardiovascular outcomes in RCTs have been mixed [4,6,[27][28][29][30]. The recent study, A Study of Cardiovascular Events in Diabetes (ASCEND) trial, of 15,480 individuals with diabetes free of prior CVD, which tested n-3 fatty acid supplementation (1 g/day) for 7.4 years, did not lower the risk of composite major vascular outcomes, while only vascular deaths were less frequent in the supplementation group than in the placebo group (RR 0.82 [95% CI 0.68, 0.98]) [31].…”

Omega-3 Blood Levels and Stroke Risk: A Pooled and Harmonized Analysis of 183 291 Participants From 29 Prospective Studies

“…2 Over the ensuing 4 decades, intensive scientific investigation established the cardioprotective effects of EPA and DHA. 3,4 A meta-analysis of 14 prospective studies used food frequency questionnaires to estimate self-reported omega-3 PUFA intake among 514 483 individuals with 9065 strokes during follow-up. 5 Compared with the lowest omega-3 intake group in each study, individuals in the highest intake group had a 13% lower risk of total stroke and a 16% lower risk of fatal stroke.…”