Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Omega-3 fatty acids: cardiovascular benefits, sources and sustainability

Nature Reviews Cardiology volume 6, pages 753–758 (2009)Cite this article

Abstract

The evidence for the cardioprotective nature of omega-3 fatty acids is abundant, and currently available data indicate that patients with known coronary heart disease should consume at least 1 g daily of long-chain omega-3 fatty acids from either oily fish or fish-oil supplements, and that individuals without disease should consume at least 250–500 mg daily. However, this area of research poses two questions. Firstly, which is the best source of omega-3 fatty acids—fish or fish-oil supplements? Secondly, are recommendations for omega-3 supplementation warranted in view of the rapid depletion of world fish stocks? The argument that eating fish is better than taking fish-oil supplements stems from the fact that several important nutrients, such as vitamin D, selenium, and antioxidants, are missing from the supplements. However, three major prevention trials have clearly indicated that omega-3 fatty acid capsules confer cardiovascular benefits and, therefore, that both are cardioprotective. Sustainable sources of omega-3 fatty acids will need to be identified if long-term cardiovascular risk reduction is to be achieved at the population level.

Key Points

  • Patients with coronary heart disease should consume at least 1 g daily of long-chain omega-3 fatty acids from oily fish or fish-oil supplements

  • Individuals without heart disease should consume 250–500 mg daily of long-chain omega-3 fatty acids from oily fish or fish-oil supplements

  • Fish-oil supplements and fish are equally good sources of omega-3 fatty acids

  • Both docosahexaenoic acid and eicosapentaenoic acid are cardioprotective and should be taken together

  • Wild fish stocks are declining, but other viable sources of omega-3 fatty acids are being investigated

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Schematic of potential dose–response curves that indicate the beneficial physiological effects for intake of long-chain omega-3 fatty acids.

References

  1. Lee, J. H., O'Keefe, J. H., Lavie, C. J., Marchioli, R. & Harris, W. S. Omega-3 fatty acids for cardioprotection. Mayo Clin. Proc. 83, 324–332 (2008).

    Article  CAS  PubMed  Google Scholar 

  2. Kris-Etherton, P. M., Harris, W. S. & Appel, L. J. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 106, 2747–2757 (2002).

    Article  PubMed  Google Scholar 

  3. Lavie, C. L., Milani, R. V., Mehra, M. R. & Ventura, H. O. Omega-3 polyunsaturated fatty acids and cardiovascular diseases—a fish tale with growing credibility. J. Am. Coll. Cardiol. 54, 585–594 (2009).

    Article  CAS  PubMed  Google Scholar 

  4. Senges, J. Randomized trial of omega-3 fatty acids on top of modern therapy after acute MI: the OMEGA-Trial. #411. Presented at the 58th Annual Scientific Sessions of the American College of Cardiology (2009).

    Google Scholar 

  5. Jenkins, D. J. A. et al. Are dietary recommendations for the use of fish oils sustainable? CMAJ 180, 633–637 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Harris, W. S. Omega-3 fatty acids and cardiovascular disease: a case for omega-3 index as a new risk factor. Pharmacol. Res. 55, 217–223 (2007).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Thies, F. et al. Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomized controlled trial. Lancet 361, 477–485 (2003).

    Article  CAS  PubMed  Google Scholar 

  8. Din, J. N. et al. Dietary intervention with oil rich fish reduces platelet-monocyte aggregation in man. Atherosclerosis 197, 290–296 (2008).

    Article  CAS  PubMed  Google Scholar 

  9. Abuissa, A., O'Keefe, J. H., Harris, W. S. & Lavie, C. J. Autonomic function, omega-3 and cardiovascular risk. Chest 127, 1088–1091 (2005).

    Article  PubMed  Google Scholar 

  10. O'Keefe, J. H., Abuissa, H., Sastre, A., Steinhaus, D. M. & Harris, W. S. Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions. Am. J. Cardiol. 97, 1127–1130 (2006).

    Article  CAS  PubMed  Google Scholar 

  11. Anand, G. R., Alkadri, M., Lavie, C. J. & Milani, R. V. The role of fish oil in arrhythmia prevention. J. Cardiopulm. Rehabil. Prev. 28, 92–98 (2008).

    Article  PubMed  Google Scholar 

  12. Ventura, H. O. et al. Cyclosporine-induced hypertension. Efficacy of omega-3 fatty acids in patients after cardiac transplantation. Circulation 88, II281–II285 (1993).

    CAS  PubMed  Google Scholar 

  13. Geleijnse, J. M. et al. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J. Hypertens. 20, 1493–1499 (2002).

    Article  CAS  PubMed  Google Scholar 

  14. Ueshima, H. et al. Food omega-3 fatty acid intake of individuals (total, linolenic acid, long-chain) and their blood pressure: INTERMAP study. Hypertension 50, 313–319 (2007).

    Article  CAS  PubMed  Google Scholar 

  15. Itoh, M. et al. Increased adiponectin secretion by highly purified eicosapentaenoic acid in rodent models of obesity and human obese subjects. Arterioscler. Thromb. Vasc. Biol. 27, 1918–1925 (2007).

    Article  CAS  PubMed  Google Scholar 

  16. Zhao, G. et al. Dietary α-linolenic acid inhibits proinflammatory cytokine production by peripheral blood mononuclear cells in hypercholesterolemic subjects. Am. J. Clin. Nutr. 85, 385–391 (2007).

    Article  CAS  PubMed  Google Scholar 

  17. Mehra, M. R., Lavie, C. J., Ventura, H. O. & Milani, R. V. Fish oils produce anti-inflammatory effects and improve body weight in severe heart failure. J. Heart Lung Transplant. 25, 834–838 (2006).

    Article  PubMed  Google Scholar 

  18. Lavie, C. J. et al. New data on clinical impact of exercise training, fish oils, and statins in heart failure. Phys. Sportsmed. 37, 22–28 (2009).

    Article  PubMed  Google Scholar 

  19. Harris, W. S., Poston, W. C. & Haddock, C. K. Tissue n-3 and n-6 fatty acids and risk for coronary heart disease events. Atherosclerosis 193, 1–10 (2007).

    Article  CAS  PubMed  Google Scholar 

  20. Metcalf, R. G. et al. Effects of fish-oil supplementation on myocardial fatty acids in humans. Am. J. Clin. Nutr. 85, 1222–1228 (2007).

    Article  CAS  PubMed  Google Scholar 

  21. Burr, M. L. et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 334, 757–761 (1989).

    Article  Google Scholar 

  22. Marchioli, R. et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation 105, 1897–1903 (2002).

    Article  CAS  PubMed  Google Scholar 

  23. Yokoyama, M. et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 369, 1090–1098 (2007).

    Article  CAS  PubMed  Google Scholar 

  24. Tavazzi, L. 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 372, 1223–1230 (2008).

    Article  PubMed  Google Scholar 

  25. Burr, M. L. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur. J. Clin. Nutr. 57, 193–200 (2003).

    Article  CAS  PubMed  Google Scholar 

  26. Nilsen, D. W. T. et al. Effects of a high-dose concentrate of n-3 fatty acids or corn oil introduced early after an acute myocardial infarction on serum triacylglycerol and HDL cholesterol. Am. J. Clin. Nutr. 74, 50–56 (2001).

    Article  CAS  PubMed  Google Scholar 

  27. von Schacky, C. & Harris, S. W. Cardiovascular benefits of omega-3 fatty acids. Cardiovasc. Res. 73, 310–315 (2007).

    Article  CAS  PubMed  Google Scholar 

  28. Saito, Y. et al. Effects of EPA on coronary artery disease in hypercholesterolemic patients with multiple risk factors: sub-analysis of primary prevention cases from the Japan EPA Lipid Intervention Study (JELIS). Atherosclerosis 200, 135–140 (2008).

    Article  CAS  PubMed  Google Scholar 

  29. He, K. et al. Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation 109, 2705–2711 (2004).

    Article  PubMed  Google Scholar 

  30. Albert, C. M. et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N. Engl. J. Med. 346, 1113–1118 (2002).

    Article  CAS  PubMed  Google Scholar 

  31. Siscovick, S. D. et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 274, 1363–1367 (1995).

    Article  CAS  PubMed  Google Scholar 

  32. Canadian Cardiovascular Society et al. 2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. J. Am. Coll. Cardiol. 51, 210–247 (2008).

  33. Van de Werf, F. et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur. Heart J. 29, 2909–2945 (2008).

    Article  CAS  PubMed  Google Scholar 

  34. Madsen, T., Schmidt, B. E. & Christensen, H. J. The effect of n-3 fatty acids on C-reactive protein levels in patients with chronic renal failure. J. Ren. Nutr. 17, 258–263 (2007).

    Article  PubMed  Google Scholar 

  35. Balk, M. E. et al. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: a systematic review. Atherosclerosis 189, 19–30 (2006).

    Article  CAS  PubMed  Google Scholar 

  36. Ouellet, V. et al. Dietary cod protein reduces plasma C-reactive protein in insulin-resistant men and women. J. Nutr. 138, 2386–2391 (2008).

    Article  CAS  PubMed  Google Scholar 

  37. Brown, M. K. & Arthur, R. J. Selenium, selenoproteins and human health: a review. Public Health Nutr. 4, 593–599 (2001).

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Holben, H. D. & Smith, M. A. The diverse role of selenium within selenoproteins: a review. J. Am. Diet Assoc. 99, 836–843 (1999).

    Article  CAS  PubMed  Google Scholar 

  40. Flores-Mateo, G., Navas-Acien, A., Pastor-Barriuso, R. & Guallar, E. Selenium and coronary heart disease: a meta-analysis. Am. J. Clin. Nutr. 84, 762–773 (2006).

    Article  CAS  PubMed  Google Scholar 

  41. Harris, S. W. et al. Comparison of the effects of fish and fish-oil capsules on the n 3 fatty acid content of blood cells and plasma phospholipids. Am. J. Clin. Nutr. 86, 1621–1625 (2007).

    Article  CAS  PubMed  Google Scholar 

  42. Mozaffarian, D. & Rimm, E. B. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA 296, 1885–1899 (2006).

    Article  CAS  PubMed  Google Scholar 

  43. US Environmental Protection Agency. Mercury Study Report to Congress [online], (2009).

  44. Foulke, J. E. Mercury in fish: cause for concern? FDA Consumer (FDA, Silver Spring, 1994).

    Google Scholar 

  45. Hightower, M. J. & Moore, D. Mercury levels in high-end consumers of fish. Environ. Health Perspect. 111, 604–608 (2003).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Clarkson, T. W., Magos, L. & Myers, G. J. The toxicology of mercury—current exposures and clinical manifestations. N. Engl. J. Med. 349, 1731–1737 (2003).

    Article  CAS  PubMed  Google Scholar 

  47. Foran, J. A. et al. Quantitative analysis of the benefits and risks of consuming farmed and wild salmon. J. Nutr. 135, 2639–2643 (2005).

    Article  CAS  PubMed  Google Scholar 

  48. Sumaila, U. R. et al. The World Trade Organization and global fisheries sustainability. Fish Res. 88, 1–4 (2007).

    Article  Google Scholar 

  49. Dulvy, N. K., Sadovy, Y. & Reynolds, J. D. Extinction vulnerability in marine populations. Fish and Fisheries 4, 25–64 (2003).

    Article  Google Scholar 

  50. Murawski, S., Methot, R. & Tromble, G. Biodiversity loss in the ocean: how bad is it? Science 316, 1281–1284 (2007).

    Article  CAS  PubMed  Google Scholar 

  51. Sands, A. S., Reid, K. J., Windsor, S. L. & Harris, W. S. The impact of age, body mass index, and fish intake on the EPA and DHA content of human erythrocytes. Lipids 40, 343–347 (2005).

    Article  CAS  PubMed  Google Scholar 

  52. Harris, W. S. et al. Stearidonic acid-enriched soybean oil increased the omega-3 index, an emerging cardiovascular risk marker. Lipids 43, 805–811 (2008).

    Article  CAS  PubMed  Google Scholar 

  53. Rajaram, S., Haddad, E. H., Mejia, A. & Sabaté, J. Walnuts and fatty fish influence different serum lipid fractions in normal to mildly hyperlipidemic individuals: a randomized controlled study. Am. J. Clin. Nutr. 89, 1657S–1663S (2009).

    Article  CAS  PubMed  Google Scholar 

  54. Miller, R. M., Nichols, D. P. & Carter, G. C. n-3 oil sources for use in aquaculture—alternatives to the unsustainable harvest of wild fish. Nutr. Res. Rev. 21, 85–96 (2008).

    Article  CAS  PubMed  Google Scholar 

  55. Bell, J. G. et al. Substituting fish oil with crude palm oil in the diet of Atlantic salmon (Salmo salar) affects muscle fatty acid composition and hepatic fatty acid metabolism. J. Nutr. 132, 222–230 (2002).

    Article  CAS  PubMed  Google Scholar 

  56. Naylor, R. L. et al. Effect of aquaculture on world fish supplies. Nature 405, 1017–1024 (2000).

    Article  CAS  PubMed  Google Scholar 

  57. Torstensen, B. E. et al. Tailoring of Atlantic salmon (Salmo salar L.) flesh lipid composition and sensory quality by replacing fish oil with a vegetable oil blend. J. Agric. Food Chem. 53, 10166–10178 (2005).

    Article  CAS  PubMed  Google Scholar 

  58. United States Department of Agriculture, Agricultural Research Service. Nutrient Data Laboratory [online], (2009).

Download references

Acknowledgements

Lori Wilson, research assistant to Dr. O'Keefe, helped coordinate manuscript construction (references) and display items, as well as to obtain permissions. She also assisted in coordinating all the coauthors' efforts.

Author information

Authors and Affiliations

  1. Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA

    John H. Lee & James H. O'Keefe

  2. Ochsner Medical Center, New Orleans, LA, USA

    Carl J. Lavie

  3. Cardiovascular Health Research Center, Sanford Research/USD and Sanford School of Medicine of the University of South Dakota, Sioux Falls, SD, USA

    William S. Harris

Authors
  1. John H. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James H. O'Keefe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carl J. Lavie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William S. Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James H. O'Keefe.

Ethics declarations

Competing interests

J. H. Lee has no conflicts of interest to disclose.

J. H. O'Keefe has received research grants from and is a consultant for Cardiotabs LLC and GlaxoSmithKline. Consultancy work for Cardiotabs LLC was unpaid.

C. J. Lavie has been a speaker and consultant for Reliant Pharmaceuticals.

W. S. Harris is a consultant for, and has received research grants from, GSK and the Monsanto Company. He has also been a speaker for GSK and is a stockholder for OmegaQuant.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lee, J., O'Keefe, J., Lavie, C. et al. Omega-3 fatty acids: cardiovascular benefits, sources and sustainability. Nat Rev Cardiol 6, 753–758 (2009). https://doi.org/10.1038/nrcardio.2009.188

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrcardio.2009.188

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing