Cardiovascular Diseases (CVDs) are the leading cause of death and disability globally, and the burden of CVD has continued to rise for decades. Some CVD risk factors, like family history, can’t be changed. Although, there are important modifiable risk factors associated with heart disease, such as diet.
Of the nutrients that support heart health, omega-3 fatty acids have stood out in the scientific and clinical communities, as evidence demonstrates that these essential fats, found primarily in fish, may significantly reduce the risk of some CVDs, including heart failure. This article aims to discuss the latest research on omega-3s and their potential role in heart failure, providing a clearer understanding of how these nutrients might affect your cardiovascular health and well-being.
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Heart Failure Overview
CVDs, also commonly called heart diseases, are a group of disorders of the heart and blood vessels. Unique factors can cause and affect the various types of CVD. For example, coronary heart disease affects the blood vessels supplying the heart, cerebrovascular disease affects the blood vessels supplying the brain, and heart failure is when the heart cannot pump sufficient blood around the body.
The heart is a muscular pump whose primary role is to push the right amount of blood around the body, delivering oxygen- and nutrient-rich blood to your cells. A healthy heart is strong enough to circulate blood throughout the body properly. Heart failure is when the heart muscle can’t pump enough blood to meet the body’s needs. The body may try to compensate for a weakening heart and might mask heart failure for some time, but as heart failure worsens, these compensations will no longer work.
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The leading causes of heart failure include chronic conditions, some of which are associated with lifestyle choices that damage or weaken the heart muscle, such as coronary heart disease or hypertension. However, heart failure can also occur suddenly, such as after a heart attack or due to congenital heart defects. Risk factors for heart failure include aging, family history, unhealthy lifestyle habits such as poor diet, physical inactivity, drug, tobacco, and alcohol use, and other health conditions that affect the blood vessels, like diabetes or obesity.
Heart failure affects approximately 6.7 million Americans and 56.2 million people globally, and heart failure mortality rates have been increasing since 2012. However, many people with heart failure can still lead whole, enjoyable lives while managing the condition. Healthy lifestyle choices can help prevent or slow down the progression of heart diseases, including heart failure.
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How Do Omega-3s Support Heart Health?Â
Dietary patterns are a modifiable risk factor that can influence heart health and the risk of heart disease. The American Heart Association (AHA) recommends a dietary lifestyle that emphasizes a wide range of fruits, vegetables, and whole grain products, choosing lean and minimally processed proteins like legumes, fish, and seafood, including non-tropical vegetable oils, and minimizing the intake of added sugar, salt, and alcohol.
The AHA also stresses that while historically dietary fats had a bad reputation, certain fats, such as unsaturated fats, are heart-healthy. The heart-healthy unsaturated fats are omega-3 fatty acids alpha-linoleic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is found mainly in plant-based foods such as olive, canola, walnut, and flaxseeds, while EPA and DHA are primarily found in marine-based algae and fatty fish like tuna, salmon, and herring.
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According to an AHA Journal publication, omega-3s have multiple favorable effects on heart health, which may comprehensively contribute to cardiovascular protection, including:
- Lower triglyceride levels and higher HDL (good cholesterol) levels
- Lower resting blood pressure
- Decrease platelet aggregation and prevent blockage of coronary arteries
- Decrease the risk of abnormal heart rhythms
- Increase compliance of arteries
- Decrease atherosclerosis
- Reduce inflammation
These effects alone or combined can have a profound influence on cardiovascular risk and CVD progression.
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Evidence of Omega-3’s Effects on Heart Health
Over the years, the number of studies demonstrating the beneficial effects of omega-3s on heart health has continued to grow. In 2021, a meta-analysis was published investigating randomized control trials with EPA/DHA interventions and cardiovascular outcomes. The outcomes included myocardial infarction, coronary heart disease (CHD) events, CVD events – such as stroke, heart failure, peripheral arterial disease, and sudden death – CHD mortality and fatal myocardial infarction.
The analysis included 40 studies and more than 135,000 participants. The researchers found that EPA + DHA significantly reduced the risk of all outcomes considered except CVD events. Although the reduction in CVD events was non-significant, a meta-regression analysis revealed that the divergence is partially due to differences in dosage and that increasing intake by 1g/day may lead to significant reductions in risk. Therefore, the researchers concluded that supplementation with EPA + DHA is a practical lifestyle strategy for CVD prevention and that the protective effects of omega-3s may increase with the dosage.
In 2023, a meta-analysis evaluated whether omega-3 supplementation can improve cardiovascular outcomes in patients with established coronary artery disease (CAD). Twelve studies and nearly 30,000 participants were included, and results indicated that omega-3s reduced the incidence of all-cause death, cardiovascular death, myocardial infarction, revascularization, sudden cardiac death, and hospitalization for heart failure or unstable angina in CAD. Interestingly, the researchers found that EPA appears to be more effective than DHA in improving the prognosis of CAD.
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Specifically concerning heart failure, a 2024 systematic review assessed the various outcomes associated with omega-3 supplementation among those with diagnosed heart failure. The review included 19 studies that evaluated multiple outcomes from mortality rate to quality of life.
The authors reported that omega-3 supplementation may improve several clinical outcomes, including hospitalization, myocardial infarction, stroke, revascularization, cardiac function, arrhythmias, and inflammation. However, the studies assessing omega-3s in the population are small and limited, and therefore, the researchers concluded that more research is required before definitive conclusions can be made.
Some of this data may indirectly tell a story about heart failure since conditions like CHD and myocardial infarction are primary risk factors for heart failure. Furthermore, the research completed on patients with symptomatic heart failure can help establish guidelines once someone is diagnosed. However, very few studies have focused on the effects of omega-3s on those at risk for heart failure but without a diagnosis.
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New Research on Omega-3s and Heart Failure
A new study (Dec 2024) investigated the association between baseline plasma levels of DHA and non-DHA omega-3 fats and the incidence of heart failure, and all-cause and CVD mortality in those with heart failure. The researchers used data from over 270,000 participants from the UK Biobank who met the inclusion criteria and had a median follow-up time of 13.7 years. This study aimed to clarify the potential of omega-3s in the prevention and management of heart failure and related mortality risks.
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Among the participants without heart failure at baseline (N=271,794), the researchers found a statistically significant, generally linear, inverse association between omega-3 levels and incident heart failure risk. The participants in the highest quintile of total omega-3s had a 23% lower risk of developing heart failure than those in the lowest quintile. Furthermore, among participants with heart failure at baseline (N=1239), the researchers observed a significant inverse relationship between all-cause mortality and CVD-related mortality and omega-3 levels. All-cause and CVD mortality were approximately 50% lower for those in the top quintile vs. those in the lowest quintile.
The researchers proposed that omega-3 fatty acids may reduce the risk of heart failure through their anti-inflammatory action and ability to counteract cardiac fibrosis, two characteristics of heart failure. This study’s outcomes align with previous evidence demonstrating that an Omega-3 Index of > or = 8% was associated with the greatest cardioprotection, whereas an Omega-3 Index of < or = 4% was associated with the least.Â
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Summary
Heart failure prevalence and incidence appear to be on the rise. Yet several modifiable risk factors, such as diet, may provide prevention and protective factors. Among heart-healthy diet recommendations, omega-3s have stood out among researchers and clinicians for their potential cardioprotective properties. While the evidence demonstrating the beneficial effects of omega-3s on cardiovascular health continues to increase, research specifically on heart failure is limited. However, newly published research shows promise.
A recent publication reported that higher levels of plasma omega-3s are associated with a lower incidence of heart failure and a reduction in mortality for those already diagnosed with heart failure. These findings support the AHA recommendations to consume 1-2 servings of seafood weekly. While omega-3s are generally considered a low-risk intervention due to their safety, more research is required to determine the definitive effects of omega-3s on heart failure outcomes and ideal omega-3 levels for preventing and improving heart failure.
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