{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T09:48:22Z","timestamp":1785836902517,"version":"3.56.0"},"reference-count":159,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Omega-3 polyunsaturated fatty acids (\u03c9-3 PUFAs), specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are critical modulators of cardiovascular physiology, acting through anti-inflammatory signaling, membrane remodeling, and transcriptional regulation. Despite strong biological plausibility, clinical evidence remains heterogeneous. This narrative review evaluates the complexities of \u03c9-3 supplementation, moving beyond standardized dosing to discuss the emerging role of biomarker-based assessments. While traditional low-dose mixed formulations often failed to show significant benefits, high-dose purified EPA (icosapent ethyl, 4 g\/day) has demonstrated a substantial reduction in residual cardiovascular risk in specific populations. However, this clinical success is accompanied by a modest but consistent increase in atrial fibrillation risk at pharmacological doses, suggesting a need for better risk stratification. We highlight that therapeutic efficacy is closely tied to bioavailability\u2014driven by chemical form and dietary context. In this setting, objective metrics such as the \u03c9-3 Index or EPA\/arachidonic acid (AA) ratio are discussed as validated biomarkers of \u03c9-3 status that, although not yet incorporated into clinical guidelines as routine treatment targets, may help account for inter-individual variability. Furthermore, we address the environmental burden of marine-derived oils, considering microalgae-based alternatives as sustainable solutions. Ultimately, this review advocates for a more nuanced approach that integrates clinical evidence, the potential of biomarker monitoring, and global environmental responsibility.<\/jats:p>","DOI":"10.3390\/nu18152538","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T09:15:22Z","timestamp":1785834922000},"page":"2538","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Omega-3 Polyunsaturated Fatty Acid Formulations in Cardiovascular Prevention: Balancing Clinical Efficacy, Safety, and Environmental Sustainability"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2462-6916","authenticated-orcid":false,"given":"Filippo","family":"Egalini","sequence":"first","affiliation":[{"name":"Lipidology and Metabolism Commission Associazione Medici Endocrinologi, 29122 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2289-8871","authenticated-orcid":false,"given":"Enrico","family":"Riccio","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Multidimensional Medicine, AUSL Toscana Centro, 50122 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Grasso","sequence":"additional","affiliation":[{"name":"Endocrine, Metabolism and Nutrition Disease Unit, Santa Maria Di Ca\u2019 Foncello Hospital, 31100 Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Nelva","sequence":"additional","affiliation":[{"name":"Lipidology and Metabolism Commission Associazione Medici Endocrinologi, 13900 Biella, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0271-9858","authenticated-orcid":false,"given":"Vincenzo","family":"De Geronimo","sequence":"additional","affiliation":[{"name":"Centro Clinico Diagnostico GB Morgagni Srl, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1146\/annurev-food-111317-095850","article-title":"Omega-3 Polyunsaturated Fatty Acids and Their Health Benefits","volume":"9","author":"Shahidi","year":"2018","journal-title":"Annu. Rev. Food Sci. Technol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"651","DOI":"10.2174\/0118715303280825231122153024","article-title":"Eicosapentaenoic Acid: Between Cardiovascular Benefits and the Risk of Atrial Fibrillation","volume":"24","author":"Egalini","year":"2024","journal-title":"Endocr. Metab. Immune Disord.-Drug Targets"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1002\/fsn3.121","article-title":"Long-Chain Polyunsaturated Fatty Acid Sources and Evaluation of Their Nutritional and Functional Properties","volume":"2","author":"Abedi","year":"2014","journal-title":"Food Sci. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1139\/bcb-2018-0342","article-title":"Low N-6\/n-3 PUFA Ratio Improves Inflammation and Myocardial Ischemic Reperfusion Injury","volume":"97","author":"Ma","year":"2019","journal-title":"Biochem. Cell Biol. Biochim. Biol. Cell"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.ypmed.2004.02.030","article-title":"The Omega-3 Index: A New Risk Factor for Death from Coronary Heart Disease?","volume":"39","author":"Harris","year":"2004","journal-title":"Prev. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.plefa.2018.03.003","article-title":"The Omega-6:Omega-3 Ratio: A Critical Appraisal and Possible Successor","volume":"132","author":"Harris","year":"2018","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1080\/00325481.2019.1607414","article-title":"The Eicosapentaenoic Acid:Arachidonic Acid Ratio and Its Clinical Utility in Cardiovascular Disease","volume":"131","author":"Nelson","year":"2019","journal-title":"Postgrad. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.atherosclerosis.2013.09.023","article-title":"Association between Ratio of Serum Eicosapentaenoic Acid to Arachidonic Acid and Risk of Cardiovascular Disease: The Hisayama Study","volume":"231","author":"Ninomiya","year":"2013","journal-title":"Atherosclerosis"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/1743-7075-8-36","article-title":"Increasing Dietary Linoleic Acid Does Not Increase Tissue Arachidonic Acid Content in Adults Consuming Western-Type Diets: A Systematic Review","volume":"8","author":"Rett","year":"2011","journal-title":"Nutr. Metab."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1017\/S0029665118002793","article-title":"Dietary Fat Composition: Replacement of Saturated Fatty Acids with PUFA as a Public Health Strategy, with an Emphasis on \u03b1-Linolenic Acid","volume":"78","author":"Lenighan","year":"2019","journal-title":"Proc. Nutr. Soc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/S0924-2244(98)00044-2","article-title":"Omega-3 Fatty Acid Concentrates: Nutritional Aspects and Production Technologies","volume":"9","author":"Shahidi","year":"1998","journal-title":"Trends Food Sci. Technol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1089\/jmf.2004.7.387","article-title":"Omega-3 (n-3) Fatty Acids in Health and Disease: Part 1\u2014Cardiovascular Disease and Cancer","volume":"7","author":"Shahidi","year":"2004","journal-title":"J. Med. Food"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1016\/j.ejphar.2011.05.085","article-title":"Fatty Acids and Inflammation: The Cutting Edge between Food and Pharma","volume":"668","author":"Calder","year":"2011","journal-title":"Eur. J. Pharmacol."},{"key":"ref_14","unstructured":"USDA FoodData Central (2026, July 02). Food Search, Available online: https:\/\/fdc.nal.usda.gov\/food-search."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/1475-2891-13-31","article-title":"U.S. Adults Are Not Meeting Recommended Levels for Fish and Omega-3 Fatty Acid Intake: Results of an Analysis Using Observational Data from NHANES 2003\u20132008","volume":"13","author":"Papanikolaou","year":"2014","journal-title":"Nutr. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"g2272","DOI":"10.1136\/bmj.g2272","article-title":"Global, Regional, and National Consumption Levels of Dietary Fats and Oils in 1990 and 2010: A Systematic Analysis Including 266 Country-Specific Nutrition Surveys","volume":"348","author":"Micha","year":"2014","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1017\/S0954422425100279","article-title":"An Overview of National and International Long Chain Omega-3 Polyunsaturated Fatty Acid Intake Recommendations for Healthy Populations","volume":"39","author":"Calder","year":"2025","journal-title":"Nutr. Res. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) (2010). Scientific Opinion on Dietary Reference Values for Fats, Including Saturated Fatty Acids, Polyunsaturated Fatty Acids, Monounsaturated Fatty Acids, Trans Fatty Acids, and Cholesterol. EFSA J., 8, 1461.","DOI":"10.2903\/j.efsa.2010.1461"},{"key":"ref_19","unstructured":"(2026, July 04). PUFA Recommendations\u2014International Society for the Study of Fatty Acids and Lipids (ISSFAL). Available online: https:\/\/www.issfal.org\/pufa-recommendations\/."},{"key":"ref_20","unstructured":"Agence Nationale de S\u00e9curit\u00e9 Sanitaire de l\u2019alimentation, de l\u2019environnement et Du Travail (2026, July 04). Opinion of the French Food Safety Agency on the Update of French Population Reference Intakes (ANCs) for Fatty Acids. Available online: https:\/\/www.anses.fr\/en\/content\/opinion-french-food-safety-agency-update-french-population-reference-intakes-ancs-fatty."},{"key":"ref_21","unstructured":"Great Britain (2004). Advice on Fish Consumption: Benefits & Risks, TSO."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) (2012). Scientific Opinion on the Tolerable Upper Intake Level of Eicosapentaenoic Acid (EPA), Docosahexaenoic Acid (DHA) and Docosapentaenoic Acid (DPA). EFSA J., 10, 2815.","DOI":"10.2903\/j.efsa.2012.2815"},{"key":"ref_23","unstructured":"Fr\u00f8yland, L., Bentsen, H., Graff, I.E., Myhrstad, M., Paulsen, J.E., Retterst\u00f8l, K., and Ulven, S.M. (2011). Evaluation of Negative and Positive Health Effects of N-3 Fatty Acids as Constituents of Food Supplements and Fortified Foods, Norwegian Scientific Committee for Food Safety (VKM)."},{"key":"ref_24","unstructured":"FAO (2010). Fats and Fatty Acids in Human Nutrition. Report of an Expert Consultation, 10\u201314 November 2008, Geneva, FAO."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1161\/CIR.0000000000000574","article-title":"Seafood Long-Chain n-3 Polyunsaturated Fatty Acids and Cardiovascular Disease: A Science Advisory From the American Heart Association","volume":"138","author":"Rimm","year":"2018","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1161\/01.ATV.14.11.1829","article-title":"The Omega-3 Fatty Acid Docosahexaenoate Reduces Cytokine-Induced Expression of Proatherogenic and Proinflammatory Proteins in Human Endothelial Cells","volume":"14","author":"Cybulsky","year":"1994","journal-title":"Arterioscler. Thromb. J. Vasc. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1161\/ATVBAHA.108.171736","article-title":"In Vivo and in Vitro Inhibition of Monocyte Adhesion to Endothelial Cells and Endothelial Adhesion Molecules by Eicosapentaenoic Acid","volume":"28","author":"Yamada","year":"2008","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/ajcn\/63.2.267","article-title":"Fish Oil Supplementation Inhibits the Expression of Major Histocompatibility Complex Class II Molecules and Adhesion Molecules on Human Monocytes","volume":"63","author":"Hughes","year":"1996","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1042\/cs1000091","article-title":"Influence of Age and Dietary Fish Oil on Plasma Soluble Adhesion Molecule Concentrations","volume":"100","author":"Miles","year":"2001","journal-title":"Clin. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1056\/NEJM199009063231006","article-title":"Leukotrienes and Other Products of the 5-Lipoxygenase Pathway. Biochemistry and Relation to Pathobiology in Human Diseases","volume":"323","author":"Lewis","year":"1990","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1056\/NEJM198505093121903","article-title":"Effect of Dietary Enrichment with Eicosapentaenoic and Docosahexaenoic Acids on in Vitro Neutrophil and Monocyte Leukotriene Generation and Neutrophil Function","volume":"312","author":"Lee","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"22254","DOI":"10.1074\/jbc.M703169200","article-title":"Enzymes and Receptors of Prostaglandin Pathways with Arachidonic Acid-Derived versus Eicosapentaenoic Acid-Derived Substrates and Products","volume":"282","author":"Wada","year":"2007","journal-title":"J. Biol. Chem."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/0006-291X(83)91572-3","article-title":"Human Neutrophil Chemotactic and Degranulating Activities of Leukotriene B5 (LTB5) Derived from Eicosapentaenoic Acid","volume":"117","author":"Goldman","year":"1983","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1006\/jsre.1998.5524","article-title":"Fish Oil Decreases Macrophage Tumor Necrosis Factor Gene Transcription by Altering the NF\u03baB Activity","volume":"82","author":"Lo","year":"1999","journal-title":"J. Surg. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1093\/ajcn\/83.2.331","article-title":"Dose-Related Effects of Eicosapentaenoic Acid on Innate Immune Function in Healthy Humans: A Comparison of Young and Older Men","volume":"83","author":"Rees","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101318","DOI":"10.1016\/j.plipres.2024.101318","article-title":"Bioavailability of EPA and DHA in Humans\u2014A Comprehensive Review","volume":"97","author":"Alijani","year":"2025","journal-title":"Prog. Lipid Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1348-0421.2001.tb01259.x","article-title":"A Role for Lipid Rafts in Immune Cell Signaling","volume":"45","author":"Katagiri","year":"2001","journal-title":"Microbiol. Immunol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1007\/s00109-004-0555-y","article-title":"Nuclear Factor-\u03baB: Its Role in Health and Disease","volume":"82","author":"Kumar","year":"2004","journal-title":"J. Mol. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1038\/nrm2083","article-title":"Integrating Cell-Signalling Pathways with NF-\u03baB and IKK Function","volume":"8","author":"Perkins","year":"2007","journal-title":"Nat. Rev. Mol. Cell Biol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"L84","DOI":"10.1152\/ajplung.00077.2002","article-title":"NF-\u03baB Inhibition by \u03c9-3 Fatty Acids Modulates LPS-Stimulated Macrophage TNF-Alpha Transcription","volume":"284","author":"Novak","year":"2003","journal-title":"Am. J. Physiol. Lung Cell. Mol. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"16683","DOI":"10.1074\/jbc.M011695200","article-title":"Saturated Fatty Acids, but Not Unsaturated Fatty Acids, Induce the Expression of Cyclooxygenase-2 Mediated through Toll-like Receptor 4","volume":"276","author":"Lee","year":"2001","journal-title":"J. Biol. Chem."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.cell.2010.07.041","article-title":"GPR120 Is an Omega-3 Fatty Acid Receptor Mediating Potent Anti-Inflammatory and Insulin-Sensitizing Effects","volume":"142","author":"Oh","year":"2010","journal-title":"Cell"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/j.1749-6632.2002.tb04261.x","article-title":"Sterol Regulatory Element-Binding Proteins (SREBPs) as Regulators of Lipid Metabolism: Polyunsaturated Fatty Acids Oppose Cholesterol-Mediated Induction of SREBP-1 Maturation","volume":"967","author":"Kim","year":"2002","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2991","DOI":"10.1128\/MCB.21.9.2991-3000.2001","article-title":"Identification of Liver X Receptor-Retinoid X Receptor as an Activator of the Sterol Regulatory Element-Binding Protein 1c Gene Promoter","volume":"21","author":"Yoshikawa","year":"2001","journal-title":"Mol. Cell. Biol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"9800","DOI":"10.1074\/jbc.M008973200","article-title":"Polyunsaturated Fatty Acids Suppress Hepatic Sterol Regulatory Element-Binding Protein-1 Expression by Accelerating Transcript Decay","volume":"276","author":"Xu","year":"2001","journal-title":"J. Biol. Chem."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s13105-016-0495-3","article-title":"Dietary Long-Chain Unsaturated Fatty Acids Acutely and Differently Reduce the Activities of Lipogenic Enzymes and of Citrate Carrier in Rat Liver","volume":"72","author":"Gnoni","year":"2016","journal-title":"J. Physiol. Biochem."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1038\/35013000","article-title":"Roles of PPARs in Health and Disease","volume":"405","author":"Kersten","year":"2000","journal-title":"Nature"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S1097-2765(00)80211-7","article-title":"PPAR\u03b3 Is Required for the Differentiation of Adipose Tissue in Vivo and in Vitro","volume":"4","author":"Rosen","year":"1999","journal-title":"Mol. Cell"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.bbadis.2011.02.014","article-title":"PPARs Are a Unique Set of Fatty Acid Regulated Transcription Factors Controlling Both Lipid Metabolism and Inflammation","volume":"1812","author":"Varga","year":"2011","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/S0022-2275(20)30473-9","article-title":"Dietary Long-Chain n-3 PUFAs Increase LPL Gene Expression in Adipose Tissue of Subjects with an Atherogenic Lipoprotein Phenotype","volume":"43","author":"Khan","year":"2002","journal-title":"J. Lipid Res."},{"key":"ref_51","unstructured":"Feingold, K.R., Adler, R.A., Ahmed, S.F., Anawalt, B., Blackman, M.R., Chrousos, G., Corpas, E., de Herder, W.W., Dhatariya, K., and Dungan, K. (2000). Introduction to Lipids and Lipoproteins. Endotext, MDText.com, Inc."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"913","DOI":"10.3945\/ajcn.2008.27054","article-title":"Red Blood Cell delta15N: A Novel Biomarker of Dietary Eicosapentaenoic Acid and Docosahexaenoic Acid Intake","volume":"89","author":"Kristal","year":"2009","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1161\/CIRCULATIONAHA.123.065520","article-title":"Randomized Trial for Evaluation in Secondary Prevention Efficacy of Combination Therapy-Statin and Eicosapentaenoic Acid (RESPECT-EPA)","volume":"150","author":"Miyauchi","year":"2024","journal-title":"Circulation"},{"key":"ref_54","first-page":"49","article-title":"Fish Oil in Primary and Secondary Cardiovascular Prevention","volume":"8","author":"Artham","year":"2008","journal-title":"Ochsner J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"375","DOI":"10.3390\/nu2030375","article-title":"Omega-3 Index and Sudden Cardiac Death","volume":"2","year":"2010","journal-title":"Nutrients"},{"key":"ref_56","first-page":"91","article-title":"Recent Studies Confirm the Utility of the Omega-3 Index","volume":"28","author":"Harris","year":"2025","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"101286","DOI":"10.1016\/j.plipres.2024.101286","article-title":"Omega-3 World Map: 2024 Update","volume":"95","author":"Schuchardt","year":"2024","journal-title":"Prog. Lipid Res."},{"key":"ref_58","first-page":"12","article-title":"The Omega-3 Index in Athletes: Brief Review","volume":"8","author":"Heileson","year":"2025","journal-title":"J. Exerc. Nutr."},{"key":"ref_59","first-page":"415","article-title":"Omega-3 Fatty Acids in Heart Disease-Why Accurately Measured Levels Matter","volume":"31","author":"Kuipers","year":"2023","journal-title":"Neth. Heart J. Mon. J. Neth. Soc. Cardiol. Neth. Heart Found."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.jacl.2024.10.009","article-title":"Assessing Omega-3 Fatty Acids-Critically Weighing Options and Relevance","volume":"19","year":"2025","journal-title":"J. Clin. Lipidol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.atherosclerosis.2017.05.007","article-title":"The Omega-3 Index and Relative Risk for Coronary Heart Disease Mortality: Estimation from 10 Cohort Studies","volume":"262","author":"Harris","year":"2017","journal-title":"Atherosclerosis"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Kim, J.Y., Kong, S.Y.J., Jung, E., and Cho, Y.S. (2024). Omega-3 Fatty Acids as Potential Predictors of Sudden Cardiac Death and Cardiovascular Mortality: A Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14010026"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1812792","article-title":"Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia","volume":"380","author":"Bhatt","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Filipovic, M.G., Reiner, M.F., Rittirsch, S., Irincheeva, I., Aeschbacher, S., Grossmann, K., Risch, M., Risch, L., Limacher, A., and Conen, D. (2021). Blood Omega-3 Fatty Acids Are Inversely Associated With Albumin-Creatinine Ratio in Young and Healthy Adults (The Omega-Kid Study). Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.622619"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Liu, X., Li, Y., Wan, X., Zhuang, P., Wu, Y., Zhang, L., Ao, Y., Yao, J., Zhang, Y., and Jiao, J. (2023). Association of Fish Oil Supplementation with Risk of Coronary Heart Disease in Individuals with Diabetes and Prediabetes: A Prospective Study in the UK Biobank. Nutrients, 15.","DOI":"10.3390\/nu15143176"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e029512","DOI":"10.1161\/JAHA.123.029512","article-title":"Association Between Omega-3 Fatty Acid Intake and Dyslipidemia: A Continuous Dose-Response Meta-Analysis of Randomized Controlled Trials","volume":"12","author":"Wang","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/s12944-017-0541-3","article-title":"Omega-3 Fatty Acids Eicosapentaenoic Acid and Docosahexaenoic Acid and Their Mechanisms of Action on Apolipoprotein B-Containing Lipoproteins in Humans: A Review","volume":"16","author":"Oscarsson","year":"2017","journal-title":"Lipids Health Dis."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"101880","DOI":"10.1016\/j.fochx.2024.101880","article-title":"Comparison of Omega-3 Polyunsaturated Fatty Acids Bioavailability in Fish Oil and Krill Oil: Network Meta-Analyses","volume":"24","author":"Pham","year":"2024","journal-title":"Food Chem. X"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.nbt.2020.02.006","article-title":"Enzymatic Modification to Produce Health-Promoting Lipids from Fish Oil, Algae and Other New Omega-3 Sources: A Review","volume":"57","year":"2020","journal-title":"New Biotechnol."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Dempsey, M., Rockwell, M.S., and Wentz, L.M. (2023). The Influence of Dietary and Supplemental Omega-3 Fatty Acids on the Omega-3 Index: A Scoping Review. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1072653"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"100548","DOI":"10.1016\/j.jlr.2024.100548","article-title":"Dietary Docosahexaenoic Acid (DHA) Downregulates Liver DHA Synthesis by Inhibiting Eicosapentaenoic Acid Elongation","volume":"65","author":"Metherel","year":"2024","journal-title":"J. Lipid Res."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1093\/ajcn\/nqaa443","article-title":"Effects of Menopausal Hormone Therapy on Erythrocyte N-3 and n-6 PUFA Concentrations in the Women\u2019s Health Initiative Randomized Trial","volume":"113","author":"Harris","year":"2021","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/lite.201600013","article-title":"Oxidation in EPA- and DHA-Rich Oils: An Overview","volume":"28","author":"Ismail","year":"2016","journal-title":"Lipid Technol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1017\/jns.2015.21","article-title":"Oxidation Levels of North American Over-the-Counter n-3 (Omega-3) Supplements and the Influence of Supplement Formulation and Delivery Form on Evaluating Oxidative Safety","volume":"4","author":"Jackowski","year":"2015","journal-title":"J. Nutr. Sci."},{"key":"ref_75","unstructured":"(2026, July 04). Certifications by Nutrasource. How Certifications Work. Available online: https:\/\/certifications.nutrasource.ca\/about\/how-certifications-work."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"15401","DOI":"10.3390\/ijms131115401","article-title":"Marine Omega-3 Phospholipids: Metabolism and Biological Activities","volume":"13","author":"Burri","year":"2012","journal-title":"Int. J. Mol. Sci."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Tocher, D.R., Betancor, M.B., Sprague, M., Olsen, R.E., and Napier, J.A. (2019). Omega-3 Long-Chain Polyunsaturated Fatty Acids, EPA and DHA: Bridging the Gap between Supply and Demand. Nutrients, 11.","DOI":"10.3390\/nu11010089"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1016\/S0140-6736(07)60527-3","article-title":"Effects of Eicosapentaenoic Acid on Major Coronary Events in Hypercholesterolaemic Patients (JELIS): A Randomised Open-Label, Blinded Endpoint Analysis","volume":"369","author":"Yokoyama","year":"2007","journal-title":"Lancet"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Yi, M., You, Y., Zhang, Y., Wu, G., Karrar, E., Zhang, L., Zhang, H., Jin, Q., and Wang, X. (2023). Highly Valuable Fish Oil: Formation Process, Enrichment, Subsequent Utilization, and Storage of Eicosapentaenoic Acid Ethyl Esters. Molecules, 28.","DOI":"10.3390\/molecules28020672"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1021\/tx200467c","article-title":"Trans Fatty Acids: Chemical Synthesis of Eicosapentaenoic Acid Isomers and Detection in Rats Fed a Deodorized Fish Oil Diet","volume":"25","author":"Ferreri","year":"2012","journal-title":"Chem. Res. Toxicol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.lwt.2018.06.004","article-title":"Effect of Deodorization Method on the Chemical and Nutritional Properties of Fish Oil during Refining","volume":"96","author":"Song","year":"2018","journal-title":"LWT"},{"key":"ref_82","unstructured":"(2026, July 04). Saturated Fatty Acid and Trans-Fatty Acid Intake for Adults and Children: WHO Guideline. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240073630."},{"key":"ref_83","first-page":"h3978","article-title":"Intake of Saturated and Trans Unsaturated Fatty Acids and Risk of All Cause Mortality, Cardiovascular Disease, and Type 2 Diabetes: Systematic Review and Meta-Analysis of Observational Studies","volume":"351","author":"Mente","year":"2015","journal-title":"BMJ"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1159\/000327785","article-title":"Importance of the Omega-6\/Omega-3 Balance in Health and Disease: Evolutionary Aspects of Diet","volume":"102","author":"Simopoulos","year":"2011","journal-title":"World Rev. Nutr. Diet."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.plipres.2009.10.001","article-title":"An Alternative to Fish Oils: Metabolic Engineering of Oil-Seed Crops to Produce Omega-3 Long Chain Polyunsaturated Fatty Acids","volume":"49","author":"Sayanova","year":"2010","journal-title":"Prog. Lipid Res."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Leung, K.S., Galano, J.-M., Durand, T., and Lee, J.C.-Y. (2018). Profiling of Omega-Polyunsaturated Fatty Acids and Their Oxidized Products in Salmon after Different Cooking Methods. Antioxidants, 7.","DOI":"10.3390\/antiox7080096"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"100856","DOI":"10.1016\/j.fochx.2023.100856","article-title":"Effects of Culinary Treatments on the Lipid Nutritional Quality of Fish and Shellfish","volume":"19","author":"Tan","year":"2023","journal-title":"Food Chem. X"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Tokarczyk, G., Bienkiewicz, G., Biernacka, P., Przybylska, S., Sawicki, W., and Tabaszewska, M. (2025). Effect of Frying Temperature on Lipid Binding, Fatty Acid Composition, and Nutritional Quality of Fish Crackers Prepared from Carp (Ciprinus carpio) and Tapioca Starch (Manihot Esculentus). Molecules, 30.","DOI":"10.3390\/molecules30051139"},{"key":"ref_89","first-page":"1","article-title":"Lower Ratio of N-3 to n-6 Fatty Acids in Cultured than in Wild Fish","volume":"51","author":"Katan","year":"1990","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"21892","DOI":"10.1038\/srep21892","article-title":"Impact of Sustainable Feeds on Omega-3 Long-Chain Fatty Acid Levels in Farmed Atlantic Salmon, 2006\u20132015","volume":"6","author":"Sprague","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_91","unstructured":"(2025, May 22). Wild-Caught vs. Farm-Raised Salmon\u2014Which Is Better for You and the Environment?. Available online: https:\/\/www.realsimple.com\/wild-caught-vs-farm-raised-salmon-8770630."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.marpolbul.2016.06.091","article-title":"Chemical Contaminants Entering the Marine Environment from Sea-Based Sources: A Review with a Focus on European Seas","volume":"112","author":"Tornero","year":"2016","journal-title":"Mar. Pollut. Bull."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Vasdravanidis, C., Alvanou, M.V., Lattos, A., Papadopoulos, D.K., Chatzigeorgiou, I., Ravani, M., Liantas, G., Georgoulis, I., Feidantsis, K., and Ntinas, G.K. (2022). Aquaponics as a Promising Strategy to Mitigate Impacts of Climate Change on Rainbow Trout Culture. Animals, 12.","DOI":"10.3390\/ani12192523"},{"key":"ref_94","unstructured":"(2025, May 23). Aquaponics\u2014Oklahoma State University. Available online: https:\/\/extension.okstate.edu\/fact-sheets\/aquaponics.html."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1111\/gcb.16019","article-title":"Commercial Fishery Disturbance of the Global Ocean Biological Carbon Sink","volume":"28","author":"Cavan","year":"2022","journal-title":"Glob. Change Biol."},{"key":"ref_96","unstructured":"(2025, May 22). Overfishing. Available online: https:\/\/www.worldwildlife.org\/threats\/overfishing."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Kazir, M., and Livney, Y.D. (2021). Plant-Based Seafood Analogs. Molecules, 26.","DOI":"10.3390\/molecules26061559"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1007\/s11745-016-4177-2","article-title":"Fish Oil and Microalga Omega-3 as Dietary Supplements: A Comparative Study on Cardiovascular Risk Factors in High-Fat Fed Rats","volume":"51","author":"Haimeur","year":"2016","journal-title":"Lipids"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"7883","DOI":"10.1080\/10408398.2025.2486267","article-title":"Microalgae as an Emerging Alternative Raw Material of Docosahexaenoic Acid and Eicosapentaenoic Acid\u2014A Review","volume":"65","author":"Sharma","year":"2025","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1186\/s40001-023-01203-6","article-title":"A Comprehensive Review of the Health Benefits of Flaxseed Oil in Relation to Its Chemical Composition and Comparison with Other Omega-3-Rich Oils","volume":"28","author":"Ashmawy","year":"2023","journal-title":"Eur. J. Med. Res."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"102542","DOI":"10.1016\/j.algal.2021.102542","article-title":"Omega-3 Fatty Acids of Microalgae as a Food Supplement: A Review of Exogenous Factors for Production Enhancement","volume":"60","author":"Perdana","year":"2021","journal-title":"Algal Res."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"00098","DOI":"10.1525\/elementa.2021.00098","article-title":"Comparative Life Cycle Assessment of Heterotrophic Microalgae Schizochytrium and Fish Oil in Sustainable Aquaculture Feeds","volume":"10","author":"McKuin","year":"2022","journal-title":"Elem. Sci. Anthr."},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Zhou, X.-R., Yao, Z.J., Benedicto, K., Nichols, P.D., Green, A., and Singh, S. (2023). New Sustainable Oil Seed Sources of Omega-3 Long-Chain Polyunsaturated Fatty Acids: A Journey from the Ocean to the Field. Sustainability, 15.","DOI":"10.3390\/su151411327"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"939","DOI":"10.3945\/jn.114.206607","article-title":"Fish Oil Contaminated with Persistent Organic Pollutants Reduces Antioxidant Capacity and Induces Oxidative Stress without Affecting Its Capacity to Lower Lipid Concentrations and Systemic Inflammation in Rats123","volume":"145","author":"Hong","year":"2015","journal-title":"J. Nutr."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"25006","DOI":"10.1007\/s11356-021-17581-5","article-title":"Assessment of the Safety of Dietary Fish Oil Supplements in Terms of Content and Quality","volume":"29","author":"Ozyurt","year":"2022","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Arena, A., Zoccali, M., Trozzi, A., Tranchida, P.Q., and Mondello, L. (2021). Occurrence of Mineral Oil Hydrocarbons in Omega-3 Fatty Acid Dietary Supplements. Foods, 10.","DOI":"10.3390\/foods10102424"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"12372","DOI":"10.1021\/acs.est.1c02922","article-title":"Evidence of Microplastic Translocation in Wild-Caught Fish and Implications for Microplastic Accumulation Dynamics in Food Webs","volume":"55","author":"McIlwraith","year":"2021","journal-title":"Environ. Sci. Technol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"110828","DOI":"10.1016\/j.foodcont.2024.110828","article-title":"Identification and Quantification of Microplastics in Omega-3 Products Using Micro Fourier Transform Infrared Spectroscopy","volume":"167","author":"Choi","year":"2025","journal-title":"Food Control"},{"key":"ref_109","unstructured":"(2025, May 23). Vegan Omega-3 Supplements Market Size Report, 2030. Available online: https:\/\/www.grandviewresearch.com\/industry-analysis\/vegan-omega-3-supplements-market-report."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1038\/s43016-021-00269-x","article-title":"Future Foods for Risk-Resilient Diets","volume":"2","author":"Tzachor","year":"2021","journal-title":"Nat. Food"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1038\/s41538-025-00386-y","article-title":"Microalgae-Enriched (Bio)Inks for 3D Bioprinting of Cultured Seafood","volume":"9","author":"Marques","year":"2025","journal-title":"npj Sci. Food"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1016\/j.jff.2014.06.023","article-title":"Algal-Oil Supplements Are a Viable Alternative to Fish-Oil Supplements in Terms of Docosahexaenoic Acid (22:6n-3; DHA)","volume":"19","author":"Ryan","year":"2015","journal-title":"J. Funct. Foods"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.jada.2008.04.020","article-title":"Algal-Oil Capsules and Cooked Salmon: Nutritionally Equivalent Sources of Docosahexaenoic Acid","volume":"108","author":"Arterburn","year":"2008","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"243","DOI":"10.5851\/kosfa.2024.e130","article-title":"Microalgae: An Exciting Alternative Protein Source and Nutraceutical for the Poultry Sector","volume":"45","author":"Zhang","year":"2025","journal-title":"Food Sci. Anim. Resour."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"100148","DOI":"10.1016\/j.ahjo.2022.100148","article-title":"Differentiating EPA from EPA\/DHA in Cardiovascular Risk Reduction","volume":"17","author":"Toth","year":"2022","journal-title":"Am. Heart J. Plus Cardiol. Res. Pract."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"e001616","DOI":"10.1136\/openhrt-2021-001616","article-title":"Icosapent Ethyl: Scientific and Legal Controversies","volume":"8","author":"Curfman","year":"2021","journal-title":"Open Heart"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1161\/CIRCULATIONAHA.122.059410","article-title":"Effects of Randomized Treatment With Icosapent Ethyl and a Mineral Oil Comparator on Interleukin-1\u03b2, Interleukin-6, C-Reactive Protein, Oxidized Low-Density Lipoprotein Cholesterol, Homocysteine, Lipoprotein(a), and Lipoprotein-Associated Phospholipase A2: A REDUCE-IT Biomarker Substudy","volume":"146","author":"Ridker","year":"2022","journal-title":"Circulation"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1001\/jama.2020.22258","article-title":"Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk: The STRENGTH Randomized Clinical Trial","volume":"324","author":"Nicholls","year":"2020","journal-title":"JAMA"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"3925","DOI":"10.1093\/eurheartj\/ehaa652","article-title":"Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis in Patients with Elevated Triglycerides on Statin Therapy: Final Results of the EVAPORATE Trial","volume":"41","author":"Budoff","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1161\/CIRCULATIONAHA.121.053144","article-title":"Omega-3 for Cardiovascular Diseases: Where Do We Stand After REDUCE-IT and STRENGTH?","volume":"144","author":"Pirillo","year":"2021","journal-title":"Circulation"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1161\/CIRCULATIONAHA.120.052209","article-title":"Effects of N-3 Fatty Acid Supplements in Elderly Patients After Myocardial Infarction: A Randomized, Controlled Trial","volume":"143","author":"Kalstad","year":"2021","journal-title":"Circulation"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/jama.2021.1489","article-title":"Effect of Marine Omega-3 Fatty Acid and Vitamin D Supplementation on Incident Atrial Fibrillation: A Randomized Clinical Trial","volume":"325","author":"Albert","year":"2021","journal-title":"JAMA"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1038\/nrn3820","article-title":"Polyunsaturated Fatty Acids and Their Metabolites in Brain Function and Disease","volume":"15","author":"Bazinet","year":"2014","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.bbalip.2014.08.010","article-title":"Marine Omega-3 Fatty Acids and Inflammatory Processes: Effects, Mechanisms and Clinical Relevance","volume":"1851","author":"Calder","year":"2015","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Dyall, S.C. (2015). Long-Chain Omega-3 Fatty Acids and the Brain: A Review of the Independent and Shared Effects of EPA, DPA and DHA. Front. Aging Neurosci., 7.","DOI":"10.3389\/fnagi.2015.00052"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3945\/an.111.000893","article-title":"Omega-3 Fatty Acids EPA and DHA: Health Benefits Throughout Life","volume":"3","author":"Swanson","year":"2012","journal-title":"Adv. Nutr."},{"key":"ref_127","unstructured":"U.S. Food and Drug (2026, February 14). FDA Approves Use of Drug to Reduce Risk of Cardiovascular Events in Certain Adult Patient Groups. Available online: https:\/\/www.prnewswire.com\/news-releases\/fda-approves-use-of-drug-to-reduce-risk-of-cardiovascular-events-in-certain-adult-patient-groups-300974813.html."},{"key":"ref_128","unstructured":"European Medicines Agency (EMA) (2026, February 14). Vazkepa. Available online: https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/vazkepa."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/eurheartj\/ehz455","article-title":"2019 ESC\/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)","volume":"41","author":"Mach","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"4359","DOI":"10.1093\/eurheartj\/ehaf190","article-title":"2025 Focused Update of the 2019 ESC\/EAS Guidelines for the Management of Dyslipidaemias","volume":"46","author":"Mach","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.jacc.2021.06.011","article-title":"2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia","volume":"78","author":"Virani","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_132","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Better Care Committee (2026). Cardiovascular Disease and Risk Management: Standards of Care in Diabetes\u20142026. Diabetes Care, 49, S157\u2013S185.","DOI":"10.2337\/dc26-SDIS"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"e867","DOI":"10.1161\/CIR.0000000000000482","article-title":"Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association","volume":"135","author":"Siscovick","year":"2017","journal-title":"Circulation"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1161\/CIR.0000000000001168","article-title":"2023 AHA\/ACC\/ACCP\/ASPC\/NLA\/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"148","author":"Virani","year":"2023","journal-title":"Circulation"},{"key":"ref_135","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1161\/CIRCULATIONAHA.121.055654","article-title":"Effect of Long-Term Marine \u03c9-3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis","volume":"144","author":"Gencer","year":"2021","journal-title":"Circulation"},{"key":"ref_139","unstructured":"European Medicines Agency (EMA) (2026, June 02). Meeting Highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 25\u201328 September 2023. Available online: https:\/\/www.ema.europa.eu\/en\/news\/meeting-highlights-pharmacovigilance-risk-assessment-committee-prac-25-28-september-2023."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.jacc.2023.05.024","article-title":"Omega-3 Fatty Acid Biomarkers and Incident Atrial Fibrillation","volume":"82","author":"Qian","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"e043031","DOI":"10.1161\/JAHA.125.043031","article-title":"Associations Between Plasma Omega-3 and Fish Oil Use With Risk of Atrial Fibrillation in the UK Biobank","volume":"14","author":"Tintle","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.pcad.2024.11.003","article-title":"Omega-3 and Risk of Atrial Fibrillation: Vagally-Mediated Double-Edged Sword","volume":"91","author":"Abuissa","year":"2025","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/S0140-6736(14)61774-8","article-title":"50 Year Trends in Atrial Fibrillation Prevalence, Incidence, Risk Factors, and Mortality in the Framingham Heart Study: A Cohort Study","volume":"386","author":"Schnabel","year":"2015","journal-title":"Lancet"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1093\/ehjcvp\/pvab008","article-title":"Omega-3 Fatty Acids Supplementation and Risk of Atrial Fibrillation: An Updated Meta-Analysis of Randomized Controlled Trials","volume":"7","author":"Lombardi","year":"2021","journal-title":"Eur. Heart J.-Cardiovasc. Pharmacother."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_146","doi-asserted-by":"crossref","unstructured":"Abuknesha, N.R., O\u2019Keefe, J.H., Qian, F., Tintle, N.L., Lin, Y., Sun, Y., Qian, H.-Z., Aisen, P.S., Albert, C.M., and Aronson, W.J. (2025). Effects of Omega-3 Fatty Acid Treatment on Risk for Atrial Fibrillation: An Updated Meta-Analysis of 34 Trials Including 114,326 Individuals 2025. medRxiv.","DOI":"10.1017\/S0029665126102493"},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1161\/CIRCULATIONAHA.121.058596","article-title":"Fishing for Links Between Omega-3 Fatty Acids and Atrial Fibrillation","volume":"145","author":"Fatkin","year":"2022","journal-title":"Circulation"},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"e026756","DOI":"10.1161\/JAHA.121.026756","article-title":"Cardiovascular Benefits of Icosapent Ethyl in Patients With and Without Atrial Fibrillation in REDUCE-IT","volume":"12","author":"Olshansky","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"e032390","DOI":"10.1161\/JAHA.123.032390","article-title":"Bleeding Risk in Patients Receiving Omega-3 Polyunsaturated Fatty Acids: A Systematic Review and Meta-Analysis of Randomized Clinical Trials","volume":"13","author":"Javaid","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1055\/s-0034-1395352","article-title":"The Effect of Omega-3 Polyunsaturated Fatty Acids on Fibrin and Thrombin Generation in Healthy Subjects and Subjects with Cardiovascular Disease","volume":"41","author":"McEwen","year":"2015","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_151","doi-asserted-by":"crossref","unstructured":"Bailey, E., Wojcik, J., Rahn, M., Roos, F., Spooren, A., and Koshibu, K. (2025). Comparative Bioavailability of DHA and EPA from Microalgal and Fish Oil in Adults. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26199343"},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.plipres.2009.07.002","article-title":"Alpha-Linolenic Acid and Its Conversion to Longer Chain n-3 Fatty Acids: Benefits for Human Health and a Role in Maintaining Tissue n-3 Fatty Acid Levels","volume":"48","author":"Murphy","year":"2009","journal-title":"Prog. Lipid Res."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1016\/j.advnut.2023.08.003","article-title":"Safety of Supplementation of Omega-3 Polyunsaturated Fatty Acids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"14","author":"Chang","year":"2023","journal-title":"Adv. Nutr."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"1645S","DOI":"10.1093\/ajcn\/65.5.1645S","article-title":"N-3 Fatty Acids and Serum Lipoproteins: Human Studies","volume":"65","author":"Harris","year":"1997","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.jacl.2011.10.018","article-title":"Effects of Eicosapentaenoic Acid and Docosahexaenoic Acid on Low-Density Lipoprotein Cholesterol and Other Lipids: A Review","volume":"6","author":"Jacobson","year":"2012","journal-title":"J. Clin. Lipidol."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1093\/cvr\/cvaa184","article-title":"Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis in Patients with Elevated Triglycerides on Statin Therapy: A Prospective, Placebo-Controlled Randomized Trial (EVAPORATE): Interim Results","volume":"117","author":"Budoff","year":"2021","journal-title":"Cardiovasc. Res."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.jacl.2011.09.001","article-title":"Effects of Prescription Omega-3-Acid Ethyl Esters, Coadministered with Atorvastatin, on Circulating Levels of Lipoprotein Particles, Apolipoprotein CIII, and Lipoprotein-Associated Phospholipase A2 Mass in Men and Women with Mixed Dyslipidemia","volume":"5","author":"Maki","year":"2011","journal-title":"J. Clin. Lipidol."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1586\/14779072.6.3.391","article-title":"Prescription Omega-3 Fatty Acids and Their Lipid Effects: Physiologic Mechanisms of Action and Clinical Implications","volume":"6","author":"Bays","year":"2008","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_159","doi-asserted-by":"crossref","unstructured":"Cartolano, F.D.C., Dias, G.D., Miyamoto, S., and Damasceno, N.R.T. (2022). Omega-3 Fatty Acids Improve Functionality of High-Density Lipoprotein in Individuals With High Cardiovascular Risk: A Randomized, Parallel, Controlled and Double-Blind Clinical Trial. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.767535"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2538\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T09:37:55Z","timestamp":1785836275000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2538"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":159,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18152538"],"URL":"https:\/\/doi.org\/10.3390\/nu18152538","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}