Nutrition researchers have known for many years that omega-3 fatty acids can help reduce the risk of cardiovascular disease (CVD). Yet 95.7 percent of Americans are not consuming enough eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 to reach cardioprotective levels. [1]
This suboptimal intake is even more concerning when you consider that by 2030, nearly 44 percent of U.S. adults will have some form of cardiovascular disease – the leading cause of death among men and women in the United States. [2] With so much of the population at risk, the science and practical points on recommending the omega-3s EPA and DHA as part of a heart-healthy diet are worth revisiting with your peers and patients.
A closer look at omega-3s
Polyunsaturated fatty acids (PUFAS) have been studied for decades – from their role in improving blood lipid levels, to enhancing endothelial function, to helping prevent plaque formation – and the findings show they can positively affect various aspects of heart health.
- Support healthy triglyceride levels: Investigators have observed significant reductions in triglyceride levels following supplementation with EPA and DHA from foods or supplements. [3] Based on American Heart Association Scientific Statements, patients who need to lower their triglyceride levels should consume a recommended 2,000-4,000 mg/day of omega-3 EPA and DHA. [4,5]
- Support arterial function: EPA and DHA may have positive effects on arterial function. [6] Omega-3 supplementation was found to improve endothelial function and reduce biomarkers of inflammation in children of parents with type 2 diabetes, suggesting that increased omega-3 intake may have long-term beneficial cardiovascular and metabolic health effects. [7]
- Support normal cardiac rhythms: Research suggests that a daily supplement of at least 1 gram of omega-3 EPA and DHA may help support normal cardiac rhythms and overall heart health in patients with existing cardiovascular disease. [4,8]
- Promote healthy living: A systematic review of the effects of fish oil supplementation, based on 12 studies with a total of nearly 33,000 patients, concluded that fish oil supplementation was associated with a significant reduction in deaths from cardiac causes. [9]
In addition to studies that demonstrate preventive heart benefits of omega-3s, there is a large and growing body of evidence demonstrating that low levels of omega-3 EPA and DHA can lead to serious health consequences. For example, one study estimated that up to 96,000 premature deaths each year in the United States are associated with low dietary intake of omega-3s. [10] A prospective cohort study in 2,692 U.S. adults age 65+ without prevalent coronary heart disease at baseline and followed for 16 years showed that higher plasma phospholipid levels of omega-3 fatty acids were associated with lower mortality, largely due to reduced CVD deaths. Individuals in the highest quintile of phospholipid omega-3 fatty acids lived an average 2.22 more years after age 65 compared to those in the lowest quintile. [11] These findings were consistent with those of other cohort studies from around the world. [12]
Omega-3s from supplements or foods?
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Since the body can only synthesize very low levels of omega-3 fatty acids, preformed EPA and DHA must be obtained predominantly from foods or through supplementation. Which forms – food or supplements – provide the greatest benefit and are easier for patients to incorporate into their lifestyle? The short answer is that both options have value. More importantly, compliance with adding omega-3s in the diet is the key to obtaining the cardioprotection, regardless of the source.
On average, Americans 19 years and older under consume omega-3s, obtaining an average of only 23 mg EPA and 63 mg DHA per day, [13] far below the 250 mg omega-3s recommended in the Dietary Guidelines for Americans. [14] Awareness of this nutrient gap allows practitioners and researchers to better understand how to help their patients reach the recommended omega-3 levels needed to make a difference.
How much omega-3 is enough? It depends on the individual, and recommendations vary. The 2015 Dietary Guidelines for Americans state “consumption of about 8 ounces per week of a variety of seafood, which provide an average consumption of 250 mg per day of EPA and DHA, is associated with reduced cardiac deaths in people with and without preexisting CVD.” [14] The American Heart Association (AHA) and the American College of Cardiology (ACC) recommend 1 g omega-3s per day from fish or fish oil capsules for secondary CVD prevention and risk reduction in patients with coronary and other atherosclerotic vascular disease. [7] For patients who need to lower triglyceride levels, the AHA recommends 2 to 4 g of EPA and DHA per day. [4] Importantly, many patients may not understand the difference between mg of fish oil and mg of EPA and DHA when choosing an omega-3 supplement.
While supplementation is beneficial, urging patients to eat more omega-3 rich foods is a critically important way to ensure healthy eating habits. In a study evaluating the risks and benefits of fish intake, researchers found that one to two servings of fish per week, especially fish high in EPA and DHA, reduced the risk of coronary death by 36 percent and total mortality by 17 percent. [15] These findings align with the recommendations on fish consumption in the Dietary Guidelines for Americans. [13]
Given that different fish species vary widely in their EPA and DHA content, it’s important to select those rich in omega-3s. To further guide your patients, the NIH U.S. National Library of Medicine offers a comprehensive resource on omega-3s and omega-3 rich foods.
The U.S. Environmental Protection Agency provides safe eating guidelines and advisories on fish and shellfish.
An evolving body of research shows that EPA and DHA can help reduce the overall risk of cardiovascular disease and protect against heart health risks. [11] Recommending patients take simple measures such as adding 1 gram of EPA and DHA as a supplement, or incorporating two servings of oily omega-3 rich fish a week, as part of a heart-healthy diet, should be a key preventative action for anyone at risk.
To learn more about omega-3s and Know Your Ω™, an educational campaign by DSM Nutritional Products, visit www.KnowYourO.com. The Know Your Ω™ website has helpful tools for both physicians and patients, sharing more information on how to best recommend omega-3 EPA and DHA and incorporate them into a balanced lifestyle.
[1] Murphy RA, Yu EA, Ciappio ED, Mehta S, McBurney MI. Suboptimal Plasma Long Chain n-3 Concentrations are Common among Adults in the United States, NHANES 2003–2004. Nutrients. 2015;7:10282-9. doi: 10.3390/nu/125534.
[2] Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016 Jan 26; 133(4):e38-e360. doi: 10.1161/CIR.0000000000000350.
[3] Leslie, MA, Cohen, DJA, Liddle, DM, Robinson, LE, and Ma, DWL. A review of the effect of omega-3 polyunsaturated fatty acids on blood triacylglycerol levels in normolipidemic and borderl3]ine hyperlipidemic individuals. Lipids in Health and Disease. 2015;14:53. doi: 10.1186/s12944-015-0049-7.
[4] Kris-Etherton PM, Harris WS, Appel LJ. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106:2747-57. doi: 10.1161/01.CIR.0000038493.65177.94.
[5] Miller M, Stone N, Ballantyne C et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011;123:2292-2333. doi: 10.1161/CIR.0b013e3182160726.
[6] Pase MP, Grima NA, Sarris J. Do long-chain n-3 fatty acids reduce arterial stiffness? A meta-analysis of randomised controlled trials. British Journal of Nutrition. 2011;106:974-80. doi: 10.1017/S0007114511002819.
[7] Rizza S, Tesauro M, Cardillo C, Galli A et al. Fish oil supplementation improves endothelial function in normoglycemic offspring of patients with type 2 diabetes. Atherosclerosis. 2009 Oct; 206(2):569-74. doi: 10.1016/j.atherosclerosis.2009.03.006.
[8] Smith SC Jr, Benjamin EJ, Bonow RO et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline From the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458-73. doi: 10.1161/CIR.0b013e318235eb4d.
[9] Leon H, Shibata MC, Sivakumaran S, Dorgan M, Chatterley T, Tsuyuki RT. Effect of fish oil on arrhythmias and mortality: systematic review. BMJ.
[10] Danaei G, Ding E, Ezzati M et al. The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6:e1000058. doi: 10.1371/journal.pmed.1000058.
[11] Mozaffarian D, Lemaitre Rn, King IB et al. Plasma phospholipid long-chain ?-3 fatty acids and total and cause-specific mortality in older adults: a cohort study. Ann Intern Med. 2013;158:515-25. doi: 10.7326/0003-4819-158-7-201304020-00003.
[12] Del Gobbo LC, Imamura F, Aslibekyan S et al. ?-3 Polyunsaturated Fatty Acid Biomarkers and Coronary Heart Disease: Pooling Project of 19 Cohort Studies. JAMA Internal Medicine. 2016;176:1155-66. doi: 10.1001/jamainternmed.2016.2925.
[13] Papanikolaou Y, Brooks J, Reider C, Fulgoni VL. U.S adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003-2008. Nutrition Journal. 2014;13:31. doi: 10.1186/1475-2891-13-31.
[14] U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
[16] Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006;296:1885-99. doi: 10.1001/jama.296.15.1885.
