Expert Blogs | Heart Health
Should You Be Taking Fish Oil? What a Cardiologist Tells Their Patients
fish oil capsules

You may have heard that it’s a good idea to take fish oil or another kind of omega-3 supplement for heart health.

Many people do – about 20 million people in the US take omega-3 supplements, mostly with the goal of preventing heart attacks and strokes.

The question is, are they wasting their money, or getting essential health benefits? The answer may depend on which type of omega-3 they are taking.

Are Fish Oil Supplements Good for Your Heart?

The story of fish oil and heart health started with the observation that several populations (like the Inuit in arctic regions) who had a high intake of fatty fish also had low rates of heart attack and stroke. Since these diets are high in polyunsaturated fats or omega-3 fatty acids, this led to the hypothesis that these fats may be useful for heart health.

A large Italian study published over 20 years ago showed that heart attack survivors who took omega-3 or “fish oil” supplements had a reduction in death, heart attack, and stroke compared to those who did not receive the supplement. These results prompted the American Heart Association to recommend fish oil supplements to patients with heart disease, and many cardiologists followed suit. It wasn’t long before the benefits of fish oil were being touted even for people without heart disease.

However, since then, several more rigorous studies (such as the VITAL study) failed to show a heart benefit from fish oil supplements.

What Does the Evidence Say?

Most doctors haven been in agreement that high-dose (3-4 grams per day) omega-3 is helpful in selected patients to lower triglycerides.

But when it came to heart attack prevention, because of the conflicting study results, cardiologists were split into two camps. Some cardiologists still advocated for omega-3 supplements in high-risk patients, and some did not. 

Then came the study that changed everything.

The REDUCE-IT trial studied high-dose pure EPA (a type of omega-3), called icosapent ethyl, in people with either established heart disease or at high-risk who were taking a statin medication and had elevated triglycerides.

And the results were remarkable.

Those who were taking the omega-3 supplement had a 25% reduction in heart disease and stroke and a 20% reduction in death from heart disease.

Why did this study have such a positive outcome when previous studies were either negative or weakly positive? Possible reasons include the higher dose used (4 grams per day), or that the omega-3 was pure EPA (and not the usual mix of EPA and DHA in most omega-3 supplements).

The truth is, we don’t know why REDUCE-IT was such a positive study. Yet, multiple national and international medical societies now recommend icosapent ethyl in high-risk patients who are taking a statin and have elevated triglyceride levels.

Should You Take Omega-3 Supplements?

The answer depends on who you ask.

Here is what I tell my patients about omega-3 supplements:

  • If there is a benefit to low-dose (1 gram per day) fish oil supplements, it is likely small. A better way to get omega-3 fatty acids is to eat fatty fish such as sardines, herring, albacore tuna, and salmon, among others. The American Heart Association recommends fish (particularly fatty fish) at least twice a week.
  • High dose (4 grams per day) of omega-3 can be effective in lowering high triglycerides.
  • If you do decide to take an omega-3 supplement, find a high-quality supplement manufactured from a reputable company.
  • Icosapent ethyl is reasonable for those at high-risk for heart disease and have elevated triglyceride levels who are taking a statin. I’m still reluctant to make a strong recommendation based on a single study, especially when that study is not consistent with other similar studies.
  • Be aware there may be risks to omega-3 supplements as well. There is a small increase in bleeding (which is why I generally don’t recommend omega-3 for my patients on strong blood thinner medication), and an increase in Afib was seen in the REDUCE-IT trial.

The story of omega-3 and heart health is a complex one, and it is not complete. Talk to your doctor to see if omega-3 supplements are right for you, and stay tuned, because more information will be coming!

Tell us what you think of this post?
0 Like
0 Sad
0 Cheered up
0 Empowered
0 Care
WebMD Expert Blog © 2020 WebMD, LLC. All rights reserved.

Important: The opinions expressed in WebMD Blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. Blogs are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.

Do not consider WebMD Blogs as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.

R. Todd Hurst, MD, FACC, FASE

R. Todd Hurst, MD, FACC, FASE

Board-certified cardiologist

R. Todd Hurst, MD, FACC, FASE, is a board-certified cardiologist, director of the Center for Cardiovascular Health  at Banner – University Medicine Heart Institute, and associate professor of medicine at the University of Arizona. His goal is to help people understand the power they have to avoid the most feared diseases such as heart attacks, strokes, and dementia.

Latest Blog Posts From R. Todd Hurst, MD, FACC

3 Things Everyone With High Blood Pressure Needs to Know

3 Things Everyone With High Blood Pressure Needs to Know

High blood pressure contributes to over 1,100deaths per day. Learn how to control your hypertension and reduce your risk.

Read more
Can Antioxidant Supplements Prevent Heart Disease? The Answer May Surprise You

Can Antioxidant Supplements Prevent Heart Disease? The Answer May Surprise You

Dozens of randomized trials looking at antioxidants have now been completed. Find out what they revealed about antioxidants and heart disease.

Read more