Effect of omega-3 supplementation vs. placebo on blood lipid levels in patients with ischemic heart disease: a systematic review and meta-analysis

Resumen del estudio

BACKGROUND AND AIM: Residual dyslipidemia persists in ischemic heart disease (IHD) patients despite statins. Omega-3 fatty acids may help, but their precise lipid effects and clinical integration need clarification. This meta-analysis aims to evaluate omega-3's impact on lipid profiles in IHD and contextualize findings within modern prevention strategies. METHODS AND RESULTS: We systematically searched PubMed, Cochrane, Web of Science, and Scopus (1988-2024) for RCTs of omega-3 (1-4 g/day EPA + DHA) versus placebo in IHD adults. Ten RCTs (n = 633) were included. Risk of bias (RoB 2) and evidence certainty (GRADE) were assessed. Random-effects meta-analysis was performed. Omega-3 significantly reduced triglycerides (MD: -17.53 mg/dL, 95% CI: -30.64 to -4.41; p = 0.009) and LDL-C (MD: -9.43 mg/dL, 95% CI: -14.20 to -4.65; p = 0.0001). A trend favored total cholesterol reduction (MD: -6.03 mg/dL, p = 0.05). HDL-C increased post-sensitivity analysis (MD: 1.66 mg/dL, p = 0.03). Heterogeneity was low (I2 = 0-31%). Evidence certainty was moderate for TG and LDL-C outcomes. CONCLUSIONS: Omega-3 supplementation significantly improves atherogenic lipids in IHD patients, supporting its adjunctive use. Implementation should prioritize high-dose EPA formulations and integrate with statin therapy within digitally-enhanced secondary prevention programs. PROSPERO REGISTRATION NUMBER: CRD42025643552. Copyright © 2026 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved. DOI: 10.1016/j.numecd.2026.104765