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Fishy Omega-3 May Keep Arteries Clear & Flexible
Study in middle-aged, multi-ethnic men links higher DHA levels to less artery calcification 05/30/2019 By Craig Weatherby

Last week, the Centers for Disease Control and Prevention delivered some bad news on heart disease.

The CDC reported that heart disease death rates among middle-aged American men and women rose by 4% from 2011 to 2017.

Buildup of calcium in your coronary arteries is a key risk factor and predictor for heart disease — and for related adverse events like heart attacks or stroke.

Just by itself, having a relatively large amount of coronary artery calcium (CAC) can prompt a diagnosis of coronary atherosclerosis — commonly called “hardening of the arteries”.

Accumulation of coronary artery calcium is caused in part by chronic arterial inflammation, generated when oxidized cholesterol and lipids (fats) adhere to artery walls — which in turn prompts more inflammation.

Your CAC score — which is determined by a CT scan — helps assess the risk for heart attacks, strokes, and other adverse outcomes. CAC scores range from zero to 400 or more (see “What do CAC scores mean, and should I get tested?”, below).

Accordingly, cardiologists use the CAC scores of people who have no symptoms of heart disease to help them and their patients decide on preventive therapies such as statins and aspirin.

Fishy omega-3s linked to reduced artery calcification
Unfortunately, misleading media stories — including reports from generally respected outlets like The New York Times and PBS TV's Frontline — have conveyed serious distortions of the overall evidence.

But as we detailed in our responses to those media reports and others, their authors overlooked the serious shortcomings of the negative clinical trials at the center of their stories.

And those misleading media reports failed to convey the highly positive overall results of most of the lab and clinical evidence about omega-3s and heart health.

Contradicting those misimpressions, recent clinical trials of prescription omega-3 drugs — which are not materially different from high potency omega-3 fish oil supplements — yielded very positive results: see Omega-3s Score 2nd Big Heart Win and Omega-3s’ Heart Value Vindicated in Long, Large Clinical Trial.

Almost certainly, some of the heart-risk-reduction benefit of omega-3 DHA and EPA flows from the fact that the body uses them to end chronic, counterproductive inflammation, which is a key risk factor for cardiovascular disease.

However, the results of several epidemiological studies also link higher fish intakes and/or higher blood levels of omega-3 DHA and/or EPA to reduced amounts of calcium in people’s arteries (Heine-Bröring RC et al. 2010; Sekikawa A et al. 2013; Alfaddagh A et al. 2019; Sekikawa A et al. 2019).

Importantly, researchers from UCLA reported finding the mechanism by which dietary omega-3s can reduce arterial calcification (Abedin M et al. 2006).

And the earlier epidemiological findings are echoed in two recent epidemiological studies: an international study involving multi-ethnic men in Japan and the US, and one involving only Japanese men.

Study #1: Omega-3 DHA linked to less arterial calcium in multi-ethnic men
This study was conducted by researchers at the University of Pittsburgh, Philadelphia’s Temple University, and two universities in Japan (Mahajan H et al. 2019).

The scientists recruited 998 forty-something men: 300 white Americans, 101 African-Americans, 287 Japanese-Americans, and 310 Japanese in Japan.

All the men underwent CT scans to determine their CAC or “Agatston” score, and blood tests to determine their omega-3 levels. About 57% of the men had some degree of arterial calcification.

Encouragingly, the results showed a 35% reduction in the participants CAC scores for every 2% increase in DHA levels.

The researchers speculated that this benefit may flow from the anti-inflammatory effects of omega-3 DHA.

As the authors wrote, “Evidence generated from this study adds to the evidence on the anti-atherosclerotic property of … [seafood source omega-3s] … especially DHA in healthy middle-aged men.”

They added, in what seems like an understatement, “Our study findings have public health significance.”

Unlike some other studies, the authors found no link between blood levels of EPA and degrees of artery calcification as reflected by CAC scores.

Study #2: Omega-3 DHA linked to less arterial calcium in Japanese men
This study comes from the same international team but involved only middle-aged Japanese men living in Japan (Sekikawa A et al. 2019).

The participants were 1,074 men aged 40-79. The researchers measured the volunteers’ artery calcification (CAC) scores, blood levels of omega-3 DHA and EPA, and other known risk factors.

And the results linked higher blood levels of DHA — but not EPA — to lower CAC scores and consequently levels of coronary atherosclerosis.

This suggestion from the study’s authors makes good sense: “Future trials are warranted comparing the effect of high-dose [supplemental] DHA and EPA on atherosclerosis and cardiovascular outcomes.”

What do CAC scores mean, and should I get tested?
Your CAC score usually predicts the amount of plaque in your coronary artery.

The result of a CAC test is expressed as a number that reflects the total area of arterial calcium deposits and the density of the arterial calcium:

  • A CAC score of zero means you have no plaque in your coronary arteries, and a correspondingly low risk for suffering a heart attack.
  • Scores ranging from 11-100 indicate some plaque and mild heart disease, with a moderate chance for a heart attack.
  • Scores ranging from 101-400 indicate a moderate amount of plaque and a moderate to high risk of a heart attack.
  • Scores over 400 indicate a 90% chance that plaque is blocking one of your arteries and that your chance of a heart attack is high.

According to guidelines issued by the American College of Cardiology and the American Heart Association, a heart CAC scan is not usually recommended for people in these categories, because it won’t add much useful information:

  • People without a family history of heart attacks at an early age.
  • People with symptoms or a diagnosis of coronary artery disease.
  • People already determined to be at high risk for coronary artery disease.
  • Men under age 40 and women under age 50, because it's unlikely calcium can be detected at younger ages.

Interestingly, very high levels of physical activity have been linked to higher levels of arterial calcification — and sometimes with a higher risk for coronary artery disease (DeFina LF et al. 2017; Laddu DR et al. 2019).

However, vigorous exercise is generally linked to better heart and overall health, so those apparent links shouldn’t be over-emphasized or taken out of context.


  • Abedin M, Lim J, Tang TB, Park D, Demer LL, Tintut Y. N-3 fatty acids inhibit vascular calcification via the p38-mitogen-activated protein kinase and peroxisome proliferator-activated receptor-gamma pathways. Circ Res. 2006 Mar 31;98(6):727-9. Epub 2006 Mar 2.
  • Alfaddagh A, Elajami TK, Saleh M, Mohebali D, Bistrian BR, Welty FK. An omega-3 fatty acid plasma index ≥4% prevents progression of coronary artery plaque in patients with coronary artery disease on statin treatment. Atherosclerosis. 2019 Jun;285:153-162. doi: 10.1016/j.atherosclerosis.2019.04.213. Epub 2019 Apr 13.
  • DeFina LF, Radford NB, Barlow CE, et al. Association of All-Cause and Cardiovascular Mortality with High Levels of Physical Activity and Concurrent Coronary Artery Calcification. JAMA Cardiol 2019;Jan 30.
  • Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary Calcium Score and Cardiovascular Risk. J Am Coll Cardiol 2018;72:434-447. DOI: 10.1016/j.jacc.2018.05.027
  • Heine-Bröring RC, Brouwer IA, Proença RV, van Rooij FJ, Hofman A, Oudkerk M, Witteman JC, Geleijnse JM. Intake of fish and marine n-3 fatty acids in relation to coronary calcification: the Rotterdam Study. Am J Clin Nutr. 2010 May;91(5):1317-23. doi: 10.3945/ajcn.2009.28416. Epub 2010 Mar 10.
  • Joshi PH, Patel B, Blaha MJ, Berry JD, Blankstein R, Budoff MJ, Wong N, Agatston A, Blumenthal RS, Nasir K. Coronary artery Calcium predicts Cardiovascular events in participants with a low lifetime risk of Cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2016 Mar;246:367-73. doi: 10.1016/j.atherosclerosis.2016.01.017. Epub 2016 Jan 13.
  • Laddu DR, Rana JS, Murillo R, Sorel ME, Quesenberry CP Jr, Allen NB, Gabriel KP, Carnethon MR, Liu K, Reis JP, Lloyd-Jones D, Carr JJ, Sidney S. 25-Year Physical Activity Trajectories and Development of Subclinical Coronary Artery Disease as Measured by Coronary Artery Calcium: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Mayo Clin Proc. 2017 Nov;92(11):1660-1670. doi: 10.1016/j.mayocp.2017.07.016. Epub 2017 Oct 16.
  • Liu W, Zhang Y, Yu CM, Ji QW, Cai M, Zhao YX, Zhou YJ. Current understanding of coronary artery calcification. J Geriatr Cardiol. 2015 Nov;12(6):668-75. doi: 10.11909/j.issn.1671-5411.2015.06.012. Review
  • Lo-Kioeng-Shioe MS, Vavere AL, Arbab-Zadeh A, Schuijf JD, Rochitte CE, Chen MY, Rief M, Kofoed KF, Clouse ME, Scholte AJ, Miller JM, Betoko A, Blaha MJ, Cox C, Deckers JW, Lima JAC. Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients: Insights From the CORE 320 Multinational Study. J Am Heart Assoc. 2019 Mar 19;8(6):e007201. doi: 10.1161/JAHA.117.007201.
  • Madhavan MV, Tarigopula M, Mintz GS, Maehara A, Stone GW, Généreux P. Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol. 2014 May 6;63(17):1703-14. doi: 10.1016/j.jacc.2014.01.017. Epub 2014 Feb 12. Review.
  • Sekikawa A, Mahajan H, Kadowaki S, Hisamatsu T, Miyagawa N, Fujiyoshi A, Kadota A, Maegawa H, Murata K, Miura K, Edmundowicz D, Ueshima H; SESSA Research Group. Association of blood levels of marine omega-3 fatty acids with coronary calcification and calcium density in Japanese men. Eur J Clin Nutr. 2019 May;73(5):783-792. doi: 10.1038/s41430-018-0242-7. Epub 2018 Jul 26.
  • Sekikawa A, Shin C, Masaki KH, Barinas-Mitchell EJ, Hirooka N, Willcox BJ, Choo J, White J, Evans RW, Fujiyoshi A, Okamura T, Miura K, Muldoon MF, Ueshima H, Kuller LH, Sutton-Tyrrell K; ERA JUMP Study Group. Association of total marine fatty acids, eicosapentaenoic and docosahexaenoic acids, with aortic stiffness in Koreans, whites, and Japanese Americans. Am J Hypertens. 2013 Nov;26(11):1321-7. doi: 10.1093/ajh/hpt107. Epub 2013 Jul 2.
  • University of Maryland Medical Center. Cardiac Calcium Scoring (Heart Scan). Accessed at

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