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Omega-3 Fatty Acid Supplementation and Vascular Health Biomarkers - A Systematic Review and Meta-Analysis
Mostafa Norouzzadeh1,2,3, Minoo Hasan Rashedi2,3, Niloofar Hamidi2,3
1The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
Insights
Omega-3 fatty acids did not significantly impact pulse wave velocity in cardiovascular disease patients. However, they improved arterial wave reflection and endothelial function, with specific doses of EPA and DHA showing greater benefits.
Area of Science:
- Cardiovascular Medicine
- Nutritional Science
- Biomarkers Research
Background:
- Cardiovascular diseases (CVDs) are a leading cause of mortality globally, often linked to vascular dysfunction.
- Dietary omega-3 fatty acids are explored for their potential to support vascular health, but efficacy and optimal dosages remain unclear.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of omega-3 fatty acids on vascular health biomarkers.
- To investigate the dose-response effects of omega-3s in individuals with CVDs.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) published up to May 2025.
- Included 20 RCTs with 1,208 participants; assessed risk of bias and certainty of evidence (GRADE).
- Analyzed effects on pulse wave velocity (PWV), augmentation index (AIx), and flow-mediated dilation (FMD).
Main Results:
- Omega-3 supplementation (0.3-4.7 g/day) did not significantly affect PWV.
- Omega-3s demonstrated improvement in AIx and enhanced FMD, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
- Optimal vascular outcomes may require approximately 1,650 mg EPA and 750 mg DHA daily, with moderate to low certainty of evidence.
Conclusions:
- Omega-3 fatty acids show potential in improving endothelial function and reducing arterial wave reflection.
- Specific dosages of EPA and DHA may be crucial for maximizing vascular benefits.
- Further rigorous trials are recommended to confirm findings and optimize clinical application.
Background:
Cardiovascular diseases (CVDs) remain the leading global cause of death, partly due to vascular dysfunction. Dietary supplements, including omega-3 fatty acids, are suggested to support vascular health, but their therapeutic effectiveness and optimal dosing are still uncertain.
Objectives:
This systematic review and meta-analysis study assessed the efficacy and dose-response effects of omega-3 fatty acids on vascular health biomarkers in individuals with CVDs.
Data Sources:
A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted through May 2025.
Study Selection:
Eligible randomized controlled trials (RCTs) with a minimum intervention duration of four weeks.
Data Extraction And Synthesis:
Two reviewers independently extracted data and assessed study quality. Data were synthesized as weighted mean differences (WMDs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane tool, and the certainty of the evidence (CoE) was appraised using the GRADE framework.
Main Outcome(S) And Measure(S):
The pulse wave velocity (PWV), augmentation index (AIx), and flow-mediated dilation (FMD).
Results:
Twenty RCTs involving 1,208 participants were included, with 80% judged at low risk of bias. Omega-3 supplementation (0.3-4.7 g/day) showed no significant effect on PWV, including in subgroups with hypertension or established CVDs. In contrast, omega-3s improved AIx. FMD elevations were greater for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) than for alpha-linolenic acid. These findings were consistent across sensitivity analyses and supported by dose-response relationships, indicating that achieving approximately 1,650 mg EPA and 750 mg DHA may be important for optimizing vascular outcomes. The CoE ranged from moderate to low.
Conclusions:
Omega-3 fatty acids may enhance endothelial function and reduce arterial wave reflection. Future trials with refined methods are needed to maximize clinical benefit.
Systematic Review Registration:
Systematic review registered with PROSPERO, registration number CRD420251065121.
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