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Review
. 2026 Jan 6:1-13.
doi: 10.1080/27697061.2025.2606059. Online ahead of print.

Omega-3 Fatty Acid Supplementation and Vascular Health Biomarkers - A Systematic Review and Meta-Analysis

Mostafa Norouzzadeh  1   2   3 , Minoo Hasan Rashedi  2   3 , Niloofar Hamidi  2   3 , Negar Karimi-Javan  2   3 , Saeed Nourian  4 , Mohammad Hasanpour  5 , Ali Arash Anoushirvani  6 , Farshad Teymoori  2   4
Affiliations
Review

Omega-3 Fatty Acid Supplementation and Vascular Health Biomarkers - A Systematic Review and Meta-Analysis

Mostafa Norouzzadeh et al. J Am Nutr Assoc. .

Abstract

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.

Keywords: Dietary supplements; cardiovascular diseases; fatty acids; hypertension; preventive cardiology; vasodilation.

Plain language summary

Omega-3 fatty acids may support vascular health, but their effectiveness and optimal dosing remain unclear, prompting evaluation of their impact on vascular biomarkers in CVDs patients.While omega-3 fatty acids did not improve PWV, they reduced AIx, indicating improved arterial wave reflection.Endothelial function responds differently to omega-3 subtypes, as EPA + DHA were more effective than ALA in improving FMD.Dose–response analyses suggest that approximately 1,650 mg EPA and 750 mg DHA per day may be needed for optimal vascular benefits.Most included RCTs had low risk of bias, but the certainty of evidence ranged from moderate to low, indicating a need for more rigorous trials.

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