learnmore

Fish and Omega-3 Fatty Acids

AHA Recommendation
Omega-3 fatty acids benefit the heart of healthy people, and those at high risk of — or who have — cardiovascular
disease.

We recommend eating fish (particularly fatty fish) at least two times a week. Fish is a good source of protein and
doesn’t have the high saturated fat that fatty meat products do. Fatty fish like mackerel, lake trout, herring,
sardines, albacore tuna and salmon are high in two kinds of omega-3 fatty acids, eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA).

We also recommend eating tofu and other forms of soybeans, canola, walnut and flaxseed, and their oils. These
contain alpha-linolenic acid (LNA), which can become omega-3 fatty acid in the body. The extent of this modification
is modest and controversial, however. More studies are needed to show a cause-and-effect relationship between
alpha-linolenic acid and heart disease.

The table below is a good guide to use for consuming omega-3 fatty acids.

Summary of Recommendations for Omega-3 Fatty Acid Intake

Population Recommendation
Patients without documented coronary heart disease (CHD) Eat a variety of (preferably fatty) fish at least twice a
week. Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts).
Patients with documented CHD Consume about 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA
supplements could be considered in consultation with the physician.
Patients who need to lower triglycerides 2 to 4 grams of EPA+DHA per day provided as capsules under a physician’
s care.

Patients taking more than 3 grams of omega-3 fatty acids from supplements should do so only under a physician’s
care. High intakes could cause excessive bleeding in some people.

Background

In 1996 the American Heart Association released its Science Advisory, “Fish Consumption, Fish Oil, Lipids and
Coronary Heart Disease.” Since then important new findings have been reported about the benefits of omega-3 fatty
acids on cardiovascular disease. These include evidence from randomized, controlled clinical trials. New
information has emerged about how omega-3 fatty acids affect heart function (including antiarrhythmic effects),
hemodynamics (cardiac mechanics) and arterial endothelial function. These findings are outlined in our November
2002 Scientific Statement, “Fish Consumption, Fish Oil, Omega-3 Fatty Acids and Cardiovascular Disease.”

The ways that omega-3 fatty acids reduce CVD risk are still being studied. However, research has shown that they

decrease risk of arrhythmias, which can lead to sudden cardiac death
decrease triglyceride levels
decrease growth rate of atherosclerotic plaque
lower blood pressure (slightly)
What do epidemiological and observational studies show?

Epidemiologic and clinical trials have shown that omega-3 fatty acids reduce CVD incidence. Large-scale
epidemiologic studies suggest that people at risk for coronary heart disease benefit from consuming omega-3 fatty
acids from plants and marine sources.

The ideal amount to take isn’t clear. Evidence from prospective secondary prevention studies suggests that taking
EPA+DHA ranging from 0.5 to 1.8 grams per day (either as fatty fish or supplements) significantly reduces deaths
from heart disease and all causes. For alpha-linolenic acid, a total intake of 1.5–3 grams per day seems beneficial.

These data support the 2000 AHA Dietary Guidelines recommendation to include at least two servings of fish
(particularly fatty fish) per week.

Randomized clinical trials have shown that omega-3 fatty acid supplements can reduce cardiovascular events
(death, non-fatal heart attacks, non-fatal strokes). They can also slow the progression of atherosclerosis in
coronary patients. However, more studies are needed to confirm and further define the health benefits of omega-3
fatty acid supplements for preventing a first or subsequent cardiovascular event. For example, placebo-controlled,
double-blind, randomized clinical trials are needed to document the safety and efficacy of omega-3 fatty acid
supplements in high-risk patients (those with type 2 diabetes, dyslipidemia, hypertension and smokers) and coronary
patients on drug therapy. Mechanistic studies on their apparent effects on sudden death also are needed.

Increasing omega-3 fatty acid intake through foods is preferable. However, coronary artery disease patients may
not be able to get enough omega-3 by diet alone. These people may want to talk to their doctor about taking a
supplement. Supplements also could help people with high triglycerides, who need even larger doses. The
availability of high-quality omega-3 fatty acid supplements, free of contaminants, is an important prerequisite to their
use