Five massive new trials have been published recently, randomizing tens of thousands to various formulations of fish oil versus placebo.
Are Fish or Fish Oil Supplements Good for the Heart?
4.8/5 - (79 votes)
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Thanks in part to the American Heart Association’s recommendation that individuals at high risk for heart disease ask their physicians about omega-3 fish oil supplementation, fish oil pills have grown into a multibillion-dollar industry. We now consume more than a hundred thousand tons of fish oil every year. But what does the science say? Are the purported benefits of fish oil supplementation for the prevention and treatment of heart disease promising, or just a fish tale?
The scientific sea change occurred a little over a decade ago when a systematic review and meta-analysis published in the Journal of the American Medical Association looked at all the best randomized clinical trials evaluating the effects of omega-3 fats on life span, cardiac death, sudden death, heart attack, and stroke. These included studies not only on fish oil supplements, but also studies on the effects of advising people to eat more oily fish. Overall, the researchers found no protective benefit for overall mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke. What about for someone who had already had a heart attack and is trying to prevent another? Still no benefit was found.
Since then, another five dozen randomized, controlled trials have been compiled, and the most extensive systematic assessment confirmed that increasing the intake of fish fats (EPA and DHA) has “little or no effect on deaths and cardiovascular events.” Longevity experiments on mice found no benefits for aging or lifespan either. Where did we even get this idea that the omega-3 fats in fish and fish oil supplements were good for us?
There was a notion that Eskimos were protected from heart disease, but that appears to be a complete myth. Some early studies, however, looked promising. For example, the famous DART trial from the 1980s involving two thousand men found that those advised to eat fatty fish had a 29 percent reduction in mortality. That’s impressive—no wonder the study got a lot of attention. Fish oil became a whale of a story that got bigger with every telling. But people seem to have forgotten about the sequel, the DART-2 trial, which found the exact opposite. Run by the same group of researchers, the DART-2 trial was an even bigger study—three thousand men—but this time, participants advised to eat oily fish, and particularly those who were supplied with fish oil capsules, had a higher risk of cardiac death. Concerns about the potential pro-arrhythmic (irregular rhythm inducing) effects of fish oil has led to reviews containing titles like “Can Fish Oil Kill You?”. But again, little or no change in overall mortality risk has been found when all the studies are put together.
Beyond just concerns about persistent pollutants, such as dioxins and PCBs in fish oil supplements—even in “distilled” fish oil supplements––oxidation by-products have been found throughout the commercial fish oil supplements industry. Surveys of popular omega-3 supplements in Asia, Europe, the Middle East, Australia, and North America found that 24-92 percent exceeded the voluntary safety standards set by the industry (there’s no legal limit, at least in the United States). The country of origin didn’t seem to matter, perhaps because most fish oil products sold globally are evidently sourced from the same region (off the West coast of South America). Surprisingly, the best-before date also wasn’t helpful (in this study where nine out of 10 supplements exceeded safety standards, they were all tested at least nine months before the best-before dates). The more expensive ones were more contaminated, but this is thought to be an artifact of higher cost relating to higher concentrations. And those obtained from algae were better than those from fish.
The United States has the highest sales of fish oil in the world, exceeding a billion dollars a year. When three top-selling fish oil supplements in the U.S. were tested, they all exceeded the recommended maximum levels of oxidation products, though expanded testing to four dozen U.S. supplements only found 52 percent exceeded the limits, though these two tests may give false positives due to added colors or flavors. A USDA study found that more than 70 percent contained less EPA and/or DHA than stated on their labels. But the greater concern is not what fish oil supplements are lacking, but rather what’s not listed on the label––like the contaminants, oxidation by-products, and saturated fat, which may explain why fish-based omega-3s raise LDL cholesterol levels compared to plant-based omega-3s.
The public health implications of consuming oxidized fish oil are unclear, however. Animal experiments suggest chronic exposure can cause inflammation, organ toxicity, and accelerated atherosclerosis, but no long-term human studies have been done. Ironically, one of the reasons there haven’t been more clinical studies are the ethical concerns knowingly exposing people to oxidized fats. Yet that experiment is being carried out en masse as we speak, in bathroom medicine cabinets around the world.
After putting all the studies together, the authors of the landmark AMA journal meta-analysis concluded that there was no longer justification for the use of omega-3s in everyday clinical practice. What should doctors do when their patients follow the American Heart Association’s advice and inquire about fish oil supplements? As the director of Lipids and Metabolism at Mount Sinai’s cardiovascular institute put it: “Given this and other negative meta-analyses, our job as doctors should be to stop highly marketed fish oil supplementation to all our patients… .”
The research momentum was already in full swing, though, and five massive new trials have been recently published randomizing tens of thousands to various formulations of fish oil versus placebo. Four out of five flopped. The so-called ASCEND trial, the OMEMI trial, the STRENGTH trial, and the VITAL trial all failed to reduce deaths or cardiovascular events, but one final nail in the coffin appeared to be loose. The REDUCE-IT trial didn’t significantly reduce overall mortality, but did reduce a composite of cardiovascular events by 25 percent. It used a prescription-only dose of EPA, equivalent to eating about 150 cans of tuna fish a day. The problem is the placebo they used.
Unlike other trials that used more neutral oils like corn oil, the drug company that funded REDUCE-IT to promote its own product chose mineral oil for the control group, a classic drug industry trick where you try to make your product look better by comparing it against something worse. And, indeed the mineral oil “placebo” increased LDL cholesterol, and caused more than a 30 percent increase in C-reactive protein. No wonder the fish oil looked good in comparison. It’s possible some fish oil formulation will eventually prove to be helpful, but for now, meta-analyses “unequivocally demonstrate that there is no cardiovascular benefit” to over-the-counter fish oil supplements.
Please consider volunteering to help out on the site.
- Kris-Etherton PM, Harris WS, Appel LJ, American Heart Association Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106(21):2747-2757.
- Shepherd CJ, Jackson AJ. Global fishmeal and fish-oil supply: inputs, outputs and markets. J Fish Biol. 2013;83(4):1046-1066.
- Goel A, Pothineni NV, Singhal M, Paydak H, Saldeen T, Mehta JL. Fish, fish oils and cardioprotection: promise or fish tale? Int J Mol Sci. 2018;19(12):3703.
- Kwak SM, Myung SK, Lee YJ, Seo HG, Korean Meta-analysis Study Group. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials. Arch Intern Med. 2012;172(9):686-694.
- Abdelhamid AS, Brown TJ, Brainard JS, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018;11(11):CD003177.
- de Magalhães JP, Müller M, Rainger GE, Steegenga W. Fish oil supplements, longevity and aging. Aging (Albany NY). 2016;8(8):1578-1582.
- Fodor JG, Helis E, Yazdekhasti N, Vohnout B. “Fishing” for the origins of the “Eskimos and heart disease” story: facts or wishful thinking? Can J Cardiol. 2014;30(8):864-868.
- Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet. 1989;2(8666):757-761.
- Rogans JA. More on fish oil. N Engl J Med. 1987;316:624-628.
- Burr ML. Secondary prevention of CHD in UK men: the Diet and Reinfarction Trial and its sequel. Proc Nutr Soc. 2007;66(1):9-15.
- Burr ML, Ashfield-Watt P a. L, Dunstan FDJ, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr. 2003;57(2):193-200.
- Asfaw A, Minhas S, Khouzam AR, Khouzam NR, Khouzam RN. Fish oil dilemma: does it increase the risk of ventricular arrhythmias and death? Can fish oil kill you? Curr Probl Cardiol. 2021;46(3):100718.
- Costa JG, Vidovic B, Saraiva N, et al. Contaminants: a dark side of food supplements? Free Radic Res. 2019;53(sup1):1113-1135.
- Ashley JT, Ward JS, Anderson CS, Schafer MW, Zaoudeh L, Horwitz RJ, Velinsky DJ. Children's daily exposure to polychlorinated biphenyls from dietary supplements containing fish oils. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2013;30(3):506-14.
- Kwon HJ, Yun HC, Lee JY, et al. Oxidative stability of omega-3 dietary supplements according to product characteristics. Anal Sci Technol. 2020;33(5):215-223.
- Damerau A, Ahonen E, Kortesniemi M, Puganen A, Tarvainen M, Linderborg KM. Evaluation of the composition and oxidative status of omega-3 fatty acid supplements on the Finnish market using NMR and SPME-GC-MS in comparison with conventional methods. Food Chem. 2020;330:127194.
- Jairoun AA, Shahwan M, Zyoud SH. Fish oil supplements, oxidative status, and compliance behaviour: regulatory challenges and opportunities. PLoS One. 2020;15(12):e0244688.
- Heller M, Gemming L, Tung C, Grant R. Oxidation of fish oil supplements in Australia. Int J Food Sci Nutr. 2019;70(5):540-550.
- Jackowski SA, Alvi AZ, Mirajkar A, et al. Oxidation levels of North American over-the-counter n-3 (omega-3) supplements and the influence of supplement formulation and delivery form on evaluating oxidative safety. J Nutr Sci. 2015;4:e30.
- Albert BB, Derraik JGB, Cameron-Smith D, et al. Fish oil supplements in New Zealand are highly oxidised and do not meet label content of n-3 PUFA. Sci Rep. 2015;5:7928.
- Ingredient label claim compliance and oxidative quality of EPA/DHA omega-3 retail products in the U.S. J Food Compos Anal. 2020;88:103435.
- Mason RP, Sherratt SCR. Omega-3 fatty acid fish oil dietary supplements contain saturated fats and oxidized lipids that may interfere with their intended biological benefits. Biochem Biophys Res Commun. 2017;483(1):425-429.
- Friedman SM, Barnett CH, Franki R, Pollock B, Garver B, Barnett TD. Jumpstarting health with a 15-day whole-food plant-based program. Am J Lifestyle Med. 2022;16(3):374-381.
- Kleiner AC, Cladis DP, Santerre CR. A comparison of actual versus stated label amounts of EPA and DHA in commercial omega-3 dietary supplements in the United States. J Sci Food Agric. 2015;95(6):1260-1267.
- Chen H, Deng G, Zhou Q, et al. Effects of eicosapentaenoic acid and docosahexaenoic acid versus α-linolenic acid supplementation on cardiometabolic risk factors: a meta-analysis of randomized controlled trials. Food Funct. 2020;11(3):1919-1932.
- Esterbauer H. Cytotoxicity and genotoxicity of lipid-oxidation products. Am J Clin Nutr. 1993;57(5 Suppl):779S-786S.
- Thiery J, Seidel D. Fish oil feeding results in an enhancement of cholesterol-induced atherosclerosis in rabbits. Atherosclerosis. 1987;63(1):53-56.
- Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012;308(10):1024-1033.
- ASCEND Study Collaborative Group, Bowman L, Mafham M, et al. Effects of n-3 fatty acid supplements in diabetes mellitus. N Engl J Med. 2018;379(16):1540-1550.
- Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380(1):11-22.
- Kalstad AA, Myhre PL, Laake K, et al. Effects of n-3 fatty acid supplements in elderly patients after myocardial infarction: a randomized, controlled trial. Circulation. 2021;143(6):528-539.
- Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the STRENGTH randomized clinical trial. JAMA. 2020;324(22):2268-2280.
- Manson JE, Cook NR, Lee IM, et al. Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. N Engl J Med. 2019;380(1):23-32.
- Mann H, Djulbegovic B. Comparator bias: why comparisons must address genuine uncertainties. J R Soc Med. 2013;106(1):30-33.
- Bostrom JA, Beckman JA, Berger JS. Summoning STRENGTH to question the placebo in REDUCE-IT. Circulation. 2021;144(6):407-409.
- Park S, Lee S, Kim Y, et al. Causal effects of serum levels of n-3 or n-6 polyunsaturated fatty acids on coronary artery disease: mendelian randomization study. Nutrients. 2021;13(5):1490.
- Nicholls SJ, Nelson AJ. The fish-oil paradox. Curr Opin Lipidol. 2020;31(6):356-361.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Thanks in part to the American Heart Association’s recommendation that individuals at high risk for heart disease ask their physicians about omega-3 fish oil supplementation, fish oil pills have grown into a multibillion-dollar industry. We now consume more than a hundred thousand tons of fish oil every year. But what does the science say? Are the purported benefits of fish oil supplementation for the prevention and treatment of heart disease promising, or just a fish tale?
The scientific sea change occurred a little over a decade ago when a systematic review and meta-analysis published in the Journal of the American Medical Association looked at all the best randomized clinical trials evaluating the effects of omega-3 fats on life span, cardiac death, sudden death, heart attack, and stroke. These included studies not only on fish oil supplements, but also studies on the effects of advising people to eat more oily fish. Overall, the researchers found no protective benefit for overall mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke. What about for someone who had already had a heart attack and is trying to prevent another? Still no benefit was found.
Since then, another five dozen randomized, controlled trials have been compiled, and the most extensive systematic assessment confirmed that increasing the intake of fish fats (EPA and DHA) has “little or no effect on deaths and cardiovascular events.” Longevity experiments on mice found no benefits for aging or lifespan either. Where did we even get this idea that the omega-3 fats in fish and fish oil supplements were good for us?
There was a notion that Eskimos were protected from heart disease, but that appears to be a complete myth. Some early studies, however, looked promising. For example, the famous DART trial from the 1980s involving two thousand men found that those advised to eat fatty fish had a 29 percent reduction in mortality. That’s impressive—no wonder the study got a lot of attention. Fish oil became a whale of a story that got bigger with every telling. But people seem to have forgotten about the sequel, the DART-2 trial, which found the exact opposite. Run by the same group of researchers, the DART-2 trial was an even bigger study—three thousand men—but this time, participants advised to eat oily fish, and particularly those who were supplied with fish oil capsules, had a higher risk of cardiac death. Concerns about the potential pro-arrhythmic (irregular rhythm inducing) effects of fish oil has led to reviews containing titles like “Can Fish Oil Kill You?”. But again, little or no change in overall mortality risk has been found when all the studies are put together.
Beyond just concerns about persistent pollutants, such as dioxins and PCBs in fish oil supplements—even in “distilled” fish oil supplements––oxidation by-products have been found throughout the commercial fish oil supplements industry. Surveys of popular omega-3 supplements in Asia, Europe, the Middle East, Australia, and North America found that 24-92 percent exceeded the voluntary safety standards set by the industry (there’s no legal limit, at least in the United States). The country of origin didn’t seem to matter, perhaps because most fish oil products sold globally are evidently sourced from the same region (off the West coast of South America). Surprisingly, the best-before date also wasn’t helpful (in this study where nine out of 10 supplements exceeded safety standards, they were all tested at least nine months before the best-before dates). The more expensive ones were more contaminated, but this is thought to be an artifact of higher cost relating to higher concentrations. And those obtained from algae were better than those from fish.
The United States has the highest sales of fish oil in the world, exceeding a billion dollars a year. When three top-selling fish oil supplements in the U.S. were tested, they all exceeded the recommended maximum levels of oxidation products, though expanded testing to four dozen U.S. supplements only found 52 percent exceeded the limits, though these two tests may give false positives due to added colors or flavors. A USDA study found that more than 70 percent contained less EPA and/or DHA than stated on their labels. But the greater concern is not what fish oil supplements are lacking, but rather what’s not listed on the label––like the contaminants, oxidation by-products, and saturated fat, which may explain why fish-based omega-3s raise LDL cholesterol levels compared to plant-based omega-3s.
The public health implications of consuming oxidized fish oil are unclear, however. Animal experiments suggest chronic exposure can cause inflammation, organ toxicity, and accelerated atherosclerosis, but no long-term human studies have been done. Ironically, one of the reasons there haven’t been more clinical studies are the ethical concerns knowingly exposing people to oxidized fats. Yet that experiment is being carried out en masse as we speak, in bathroom medicine cabinets around the world.
After putting all the studies together, the authors of the landmark AMA journal meta-analysis concluded that there was no longer justification for the use of omega-3s in everyday clinical practice. What should doctors do when their patients follow the American Heart Association’s advice and inquire about fish oil supplements? As the director of Lipids and Metabolism at Mount Sinai’s cardiovascular institute put it: “Given this and other negative meta-analyses, our job as doctors should be to stop highly marketed fish oil supplementation to all our patients… .”
The research momentum was already in full swing, though, and five massive new trials have been recently published randomizing tens of thousands to various formulations of fish oil versus placebo. Four out of five flopped. The so-called ASCEND trial, the OMEMI trial, the STRENGTH trial, and the VITAL trial all failed to reduce deaths or cardiovascular events, but one final nail in the coffin appeared to be loose. The REDUCE-IT trial didn’t significantly reduce overall mortality, but did reduce a composite of cardiovascular events by 25 percent. It used a prescription-only dose of EPA, equivalent to eating about 150 cans of tuna fish a day. The problem is the placebo they used.
Unlike other trials that used more neutral oils like corn oil, the drug company that funded REDUCE-IT to promote its own product chose mineral oil for the control group, a classic drug industry trick where you try to make your product look better by comparing it against something worse. And, indeed the mineral oil “placebo” increased LDL cholesterol, and caused more than a 30 percent increase in C-reactive protein. No wonder the fish oil looked good in comparison. It’s possible some fish oil formulation will eventually prove to be helpful, but for now, meta-analyses “unequivocally demonstrate that there is no cardiovascular benefit” to over-the-counter fish oil supplements.
Please consider volunteering to help out on the site.
- Kris-Etherton PM, Harris WS, Appel LJ, American Heart Association Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106(21):2747-2757.
- Shepherd CJ, Jackson AJ. Global fishmeal and fish-oil supply: inputs, outputs and markets. J Fish Biol. 2013;83(4):1046-1066.
- Goel A, Pothineni NV, Singhal M, Paydak H, Saldeen T, Mehta JL. Fish, fish oils and cardioprotection: promise or fish tale? Int J Mol Sci. 2018;19(12):3703.
- Kwak SM, Myung SK, Lee YJ, Seo HG, Korean Meta-analysis Study Group. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials. Arch Intern Med. 2012;172(9):686-694.
- Abdelhamid AS, Brown TJ, Brainard JS, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018;11(11):CD003177.
- de Magalhães JP, Müller M, Rainger GE, Steegenga W. Fish oil supplements, longevity and aging. Aging (Albany NY). 2016;8(8):1578-1582.
- Fodor JG, Helis E, Yazdekhasti N, Vohnout B. “Fishing” for the origins of the “Eskimos and heart disease” story: facts or wishful thinking? Can J Cardiol. 2014;30(8):864-868.
- Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet. 1989;2(8666):757-761.
- Rogans JA. More on fish oil. N Engl J Med. 1987;316:624-628.
- Burr ML. Secondary prevention of CHD in UK men: the Diet and Reinfarction Trial and its sequel. Proc Nutr Soc. 2007;66(1):9-15.
- Burr ML, Ashfield-Watt P a. L, Dunstan FDJ, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr. 2003;57(2):193-200.
- Asfaw A, Minhas S, Khouzam AR, Khouzam NR, Khouzam RN. Fish oil dilemma: does it increase the risk of ventricular arrhythmias and death? Can fish oil kill you? Curr Probl Cardiol. 2021;46(3):100718.
- Costa JG, Vidovic B, Saraiva N, et al. Contaminants: a dark side of food supplements? Free Radic Res. 2019;53(sup1):1113-1135.
- Ashley JT, Ward JS, Anderson CS, Schafer MW, Zaoudeh L, Horwitz RJ, Velinsky DJ. Children's daily exposure to polychlorinated biphenyls from dietary supplements containing fish oils. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2013;30(3):506-14.
- Kwon HJ, Yun HC, Lee JY, et al. Oxidative stability of omega-3 dietary supplements according to product characteristics. Anal Sci Technol. 2020;33(5):215-223.
- Damerau A, Ahonen E, Kortesniemi M, Puganen A, Tarvainen M, Linderborg KM. Evaluation of the composition and oxidative status of omega-3 fatty acid supplements on the Finnish market using NMR and SPME-GC-MS in comparison with conventional methods. Food Chem. 2020;330:127194.
- Jairoun AA, Shahwan M, Zyoud SH. Fish oil supplements, oxidative status, and compliance behaviour: regulatory challenges and opportunities. PLoS One. 2020;15(12):e0244688.
- Heller M, Gemming L, Tung C, Grant R. Oxidation of fish oil supplements in Australia. Int J Food Sci Nutr. 2019;70(5):540-550.
- Jackowski SA, Alvi AZ, Mirajkar A, et al. Oxidation levels of North American over-the-counter n-3 (omega-3) supplements and the influence of supplement formulation and delivery form on evaluating oxidative safety. J Nutr Sci. 2015;4:e30.
- Albert BB, Derraik JGB, Cameron-Smith D, et al. Fish oil supplements in New Zealand are highly oxidised and do not meet label content of n-3 PUFA. Sci Rep. 2015;5:7928.
- Ingredient label claim compliance and oxidative quality of EPA/DHA omega-3 retail products in the U.S. J Food Compos Anal. 2020;88:103435.
- Mason RP, Sherratt SCR. Omega-3 fatty acid fish oil dietary supplements contain saturated fats and oxidized lipids that may interfere with their intended biological benefits. Biochem Biophys Res Commun. 2017;483(1):425-429.
- Friedman SM, Barnett CH, Franki R, Pollock B, Garver B, Barnett TD. Jumpstarting health with a 15-day whole-food plant-based program. Am J Lifestyle Med. 2022;16(3):374-381.
- Kleiner AC, Cladis DP, Santerre CR. A comparison of actual versus stated label amounts of EPA and DHA in commercial omega-3 dietary supplements in the United States. J Sci Food Agric. 2015;95(6):1260-1267.
- Chen H, Deng G, Zhou Q, et al. Effects of eicosapentaenoic acid and docosahexaenoic acid versus α-linolenic acid supplementation on cardiometabolic risk factors: a meta-analysis of randomized controlled trials. Food Funct. 2020;11(3):1919-1932.
- Esterbauer H. Cytotoxicity and genotoxicity of lipid-oxidation products. Am J Clin Nutr. 1993;57(5 Suppl):779S-786S.
- Thiery J, Seidel D. Fish oil feeding results in an enhancement of cholesterol-induced atherosclerosis in rabbits. Atherosclerosis. 1987;63(1):53-56.
- Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012;308(10):1024-1033.
- ASCEND Study Collaborative Group, Bowman L, Mafham M, et al. Effects of n-3 fatty acid supplements in diabetes mellitus. N Engl J Med. 2018;379(16):1540-1550.
- Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380(1):11-22.
- Kalstad AA, Myhre PL, Laake K, et al. Effects of n-3 fatty acid supplements in elderly patients after myocardial infarction: a randomized, controlled trial. Circulation. 2021;143(6):528-539.
- Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the STRENGTH randomized clinical trial. JAMA. 2020;324(22):2268-2280.
- Manson JE, Cook NR, Lee IM, et al. Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. N Engl J Med. 2019;380(1):23-32.
- Mann H, Djulbegovic B. Comparator bias: why comparisons must address genuine uncertainties. J R Soc Med. 2013;106(1):30-33.
- Bostrom JA, Beckman JA, Berger JS. Summoning STRENGTH to question the placebo in REDUCE-IT. Circulation. 2021;144(6):407-409.
- Park S, Lee S, Kim Y, et al. Causal effects of serum levels of n-3 or n-6 polyunsaturated fatty acids on coronary artery disease: mendelian randomization study. Nutrients. 2021;13(5):1490.
- Nicholls SJ, Nelson AJ. The fish-oil paradox. Curr Opin Lipidol. 2020;31(6):356-361.
Motion graphics by Avo Media
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Title
Are Fish or Fish Oil Supplements Good for the Heart?
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
For more on fish oil, see:
- PCBs in Children’s Fish Oil Supplements
- Omega-3s and the Eskimo Fish Tale
- Omega 3s, Prostate Cancer, and Atrial Fibrillation
- Is Fish Oil Just Snake Oil?
- Fish and Diabetes
- Dietary Sources of Alkylphenol Endocrine Disruptors
For more on DHA and Pregnancy, check out the podcast.
Want to know my omega-3 recommendations? See my Optimum Nutrient Recommendations.
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