Exploring the Benefits of Omega-3 for Heart Health
Patients often ask me which supplements they should take. They may be disappointed to learn that my answer is often equivocal because the rigor of evidence is quite low when it comes to supplements. That is not to say a supplement is not beneficial, it just means we may not have strong research to back it up.
One supplement I get asked about a lot is Omega-3. Omega-3 has reported benefits from heart health to improved learning and memory. Unfortunately, the research on Omega-3 and cardiovascular disease has produced inconsistent results. In this blog post we will review the benefits and conflict of Omega-3 supplements.
Let’s start with some background.
Understanding Omega-3:
What is Omega-3?
Omega-3 fatty acids are a type of polyunsaturated fatty acid that are essential for human health, but cannot be synthesized by the body and must be obtained through diet.
There are two main omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are found mainly in fish and fish oil. There is a third type, Alpha-linolenic acid (ALA) , which is primarily found in plant sources like walnuts, flaxseeds, and canola oil. ALA can be converted into the longer-chain omega-3s EPA and DHA, but this conversion is limited.
Omega-3 is essential for cell membrane structure and function. Research indicates that omega-3 fatty acids can help reduce inflammation and cardiovascular disease, protect against stress-related cellular damage, and potentially slow down the effects of aging.
Natural sources of Omega-3 in the diet include fatty fish like salmon, sardines, and tuna, nuts and seeds, like walnuts and flaxseed, and some in algae and leafy greens.
How does Omega-3 work?
Omega-3 fatty acids have anti-inflammatory properties and have been shown to reduce the production of inflammatory molecules like prostaglandin E2 and leukotriene B4. There is some evidence that they can make cells less inflammatory and lead to reduced levels of C-reactive protein, a marker of inflammation in the body. Omega-3 can also be incorporated into the cell membrane to influence cell structure and function.
When did people start using Omega-3 as a supplement?
The widespread adoption of omega-3 supplements, particularly fish oil, gained momentum in the latter half of the 20th century. In the 1920s, landmark research by the Burr couple discovered that certain fatty acids, including omega-3s, were "essential" nutrients that the body could not produce on its own. This sparked interest in supplementation which has been enduring in popularity today.
Research on Omega-3 and Cardiovascular Health
The American Heart Association has endorsed Omega-3 supplements for 20 years for their benefits to heart health and for reducing cardiovascular events like stroke. Omega-3 supplementation may also help lower bad cholesterol levels.
However, the research has not all been conclusive - certain types or brands of omega-3 supplements may have varying effects on cardiovascular health. Research suggests that a pure EPA supplement, or one with a higher EPA content compared to DHA, may be more beneficial for cardiovascular health.
Vascepa is an FDA-approved prescription Omega-3 with a purified EPA supplement that has been shown to reduce heart attacks, strokes, and other cardiovascular events.
The REDUCE-IT trial was a study designed to look at the benefits of Omega-3 for elevated triglycerides and heart health. This study enrolled over 8,000 patients with elevated cardiovascular risk and high blood triglyceride levels. They assigned half of the study participants to receive 2 grams of Vascepa twice a day, and assigned the other participants a placebo. Vascepa reduced blood triglyceride levels, but more importantly, it reduced the number of heart attacks and strokes, the need for a heart stenting procedure for clogged arteries, and death. Another meta-analysis confirmed beneficial findings of omega 3 on cardiovascular disease risk risk.
On the other hand, the STRENGTH trial, which tested a combination of EPA and DHA, did not show significant benefits in terms of cardiovascular outcomes. This trial used a different formulation of Omega-3. This study enrolled over 13,000 patients who were randomized to receive either the EPA/DHA combination pill or the placebo (a pill filled with corn oil). The trial was terminated early due to an interim analysis revealing no difference between the two treatment groups
This discrepancy raises questions about the specific formulations and ratios of omega-3 fatty acids in supplements and their impact on heart health. While more research is needed to fully understand the effects of different omega-3 formulations, opting for a supplement with higher EPA content hold promise for for cardiovascular health.
Deciding whether or not to Supplement with Omega-3
While a prescription for Vascepa is reserved for specific high-risk patients, supplementing with an over-the-counter Omega-3 may be right for you depending on your risk factors and cholesterol levels. This ideally should be combined with a heart-healthy diet, regular exercise, and other positive lifestyle changes. In the end you can’t out supplement less than ideal habits, so positive healthy living should be foundational before you consider adding in a supplement.
Note: The information provided in this article is for educational purposes only and should not be considered medical advice. Always consult with your personal doctor or healthcare professional before starting any new supplement or making changes to your current regimen.
