At the heart of the matter: most comprehensive quantitative analysis of the effect of EPA and DHA on coronary heart disease
According to the World Health Organization, by 2030 almost 23.6 million people will die from cardiovascular diseases (CVDs) - mainly from coronary heart disease (CHD) and stroke, which are projected to remain the single leading causes of death. CHD is caused by a build-up of fatty deposits on the walls of the coronary arteries. A new comprehensive meta-analysis has been conducted to assess the effect of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) on CHD. The research also aims to estimate the association between EPA and DHA intake and CHD risk.
The meta-analysis, funded by the Global Organization for EPA and DHA (GOED) and led by principal investigator Dominik D. Alexander from the Department of Epidemiology at the EpidStat Institute, aimed to examine the effects of different doses of EPA and DHA, as well as particular outcomes among higher-risk populations. To date, the study is the most comprehensive quantitative analysis of its kind within peer reviewed biomedical literature. The inclusion criteria were specific for CHD, unlike other meta-analyses that include a mixture of vascular and other coronary outcomes. This study used data from two types of studies:
1) 18 randomized controlled trials (RCTs), including 93,000 subjects
2) 16 prospective cohort studies, including 732,000 subjects.
Study populations included non-hospitalized adults, older than 18 years of age, with and without CHD and free of significant non-CHD related disease history.
The key findings of the meta-analysis include:
- EPA and DHA supplementation produced a non-statistically significant 6% reduction of CHD.
- EPA and DHA supplementation significantly reduced CHD risk by 16% among people with elevated serum triglycerides (>150 mg/dL), however not among those with triglyceride levels with normal limits. In addition, higher dose (> 1000 mg/d of EPA and DHA) had a stronger impact among those with elevated triglycerides compared to trials with a dose less than <1000 mg/d.
- EPA and DHA supplementation significantly reduced CHD risk by 14% among people with higher low-density lipoprotein (LDL) cholesterol (>130 mg/dL), but not for those with LDL cholesterol below 130 mg/dL.
- The subsequent meta-analysis of prospective cohort studies found that EPA and DHA supplementation significantly reduced CHD risk by 18%.
The results of this meta-analysis adds to recent research, which confirms that adequate intake of EPA and DHA may reduce risk of CHD among people with elevated blood levels of triglycerides or LDL-cholesterol, both major risk factors that affect a significant portion of the general adult population globally. The threat of elevated triglycerides and LDL-cholesterol to health has grown out of poor eating habits and dietary changes occurring in developed countries. Increased consumption of processed foods that contain trans fats (including partially hydrogenated oils), saturated fats and high fructose corn syrup, which the human body has been unable to fully adapt, are the primary drivers for increased triglyceride and LDL cholesterol levels that contribute to heart disease and obesity.
A vast majority of the global population suffer from omega-3 deficiency. 83% of the global population live in countries where the average intake of EPA and DHA is below the minimum WHO guidelines. In the U.S. almost 96% of the population has an EPA and DHA level below what’s needed to provide cardiovascular protection. To achieve cardiovascular benefits, it is necessary to receive an intake that is significantly above the level of the general recommendation of 250 mg of EPA and DHA per day. This new research supports the view that an intake of 1000 mg per day of EPA and DHA should be a goal to optimize cardiovascular health. Dietary supplements and fortified foods are the most convenient way to ensure that these levels can be reached. All of the studies analyzed except one provided EPA and DHA in combination in varying doses, and as a result more RCTs are needed to fully evaluate the relationship between the dose of EPA and DHA, alone or in combination, for reducing CHD outcomes.
Recent studies clearly demonstrate that the public health and economic benefits of supplementation outweigh the costs. For example, one study has found that regular consumption of EPA and DHA omega-3 fatty acids supplements could save substantial healthcare costs in the European Union (EU). Overall, 24% of the people aged 55+ in the EU are considered to be at risk of experiencing a hospital event attributed to cardiovascular disease (CVD). The findings indicate that this risk could be reduced by 4.9% through daily consumption of 1,000 mg of EPA and DHA. This corresponds to more than 1.5 million fewer CVD-attributed hospital events from now up through 2020, generating cost savings of €12.9 billion per annum. For the US, a report from 2013 states that the savings potential in avoided CVD-attributed hospital events, from EPA and DHA omega-3 fatty acids supplements at preventive levels, would average nearly $500 USD million per year - a $3.90 billion USD cumulative health care cost savings from 2013 to 2020.
With evidence to show that a diet low in EPA and DHA may be a contributor to heart disease, health authorities recommend intake of EPA and DHA for heart and overall health. The findings of the new meta-analysis are a stimulus for more research in the field of EPA and DHA for heart health. They should encourage health authorities, as well as healthcare professionals, to dedicate more attention to the essential role, intake, and status of EPA and DHA in human health.
Coming soon: In February, the world will once again welcome heart health month. Keep an eye out for our blog.
- For more information on the impact of EPA and DHA on human health, click here to download the whitepaper on benefits of optimal EPA and DHA intake.
 Mozaffarian 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, and Arnoldussen et al, Early intake of long-chain polyunsaturated fatty acids preserves brain structure and function in diet-induced obesity, J Nutr Biochem 2016
 Global Burden of Diseases Nutrition & Chronic Diseases Expert Group (NutriCoDE) www.bmj.com/content/348/bmj.g2272.long
Stark et al, Global survey of the omega-3 fatty acids, docosahexaenoic acid and eicosapentaenoic acid in the blood stream of healthy adults, J Pr in Lip Res 2016
 Murphy et al, Suboptimal Plasma Long Chain n-3 Concentrations are Common among Adults in the United States, NHANES 2003-2004, Nutrients 2015