British Journal of Nutrition

Systematic Review with Meta-analysis

Impact of low v. moderate intakes of long-chain n-3 fatty acids on risk of coronary heart disease

Kathy Musa-Velosoa1 c1, Malcolm A. Binnsa2, Alexandra Kocenasa1, Catherine Chunga1, Harry Ricea3, Hilde Oppedal-Olsena4, Hilary Lloyda5 and Shawna Lemkea6

a1 Cantox Health Sciences International, An Intertek Company, 2233 Argentia Road, Suite 308, Mississauga, Ontario, Canada, L5N 2X7

a2 University of Toronto, Toronto, Ontario, Canada

a3 Global Organization for EPA and DHA Omega-3s (GOED), Salt Lake City, UT, USA

a4 Denomega Nutritional Oils AS, Sarpsborg, Norway

a5 Ocean Nutrition Canada, Dartmouth, Nova Scotia, Canada

a6 Monsanto, St Louis, MO, USA


The objective of the present study was to determine whether the consumption of ≥ 250 v. < 250 mg of the long-chain n-3 fatty acids (n-3 LCFA) per d is associated with a reduction in the risk of fatal and non-fatal CHD in individuals with no prior history of CHD. A comprehensive and systematic review of the published scientific literature resulted in the identification of eight prospective studies (seven cohorts and one nested case–control study) that met predefined inclusion criteria. Relative to the consumption of < 250 mg n-3 LCFA per d, the consumption of ≥ 250 mg/d was associated with a significant 35·1 % reduction in the risk of sudden cardiac death and a near-significant 16·6 % reduction in the risk of total fatal coronary events, while the risk of non-fatal myocardial infarction was not significantly reduced. In several meta-analyses, which were based on US studies, risk of CHD death was found to be dose-dependently reduced by the n-3 LCFA, with further risk reductions observed with intakes in excess of 250 mg/d. Prospective observational and intervention data from Japan, where intake of fish is very high, suggest that n-3 LCFA intakes of 900 to 1000 mg/d and greater may confer protection against non-fatal myocardial infarction. Thus, the intake of 250 mg n-3 LCFA per d may, indeed, be a minimum target to be achieved by the general population for the promotion of cardiovascular health.

(Received March 09 2010)

(Revised February 02 2011)

(Accepted February 14 2011)

(Online publication May 31 2011)

Key Words:

  • EPA;
  • DHA;
  • n-3 Fatty acids;
  • Heart disease;
  • Coronary heart disease


c1 Corresponding author: Dr K. Musa-Veloso, fax +1 905 542 1011, email


Abbreviations: HR, hazard ratio; n-3 LCFA, long-chain n-3 fatty acid; RR, relative risk