Omega-3 Fatty Acids (EPA/DHA)
Long-chain marine omega-3s don't just float around. EPA and DHA move into cell membrane phospholipids and set up shop, serving as substrates for anti-inflammatory resolvins and protectins. They also lower serum triglycerides by cutting hepatic VLDL synthesis, and they take the edge off systemic inflammation more broadly. Here's the flex: in observational cohorts, higher omega-3 status tracks with longer leukocyte telomere length.
Evidence
REDUCE-IT and the pooled meta-analyses agree: triglycerides drop, and some cardiovascular event endpoints improve too. That's not nothing. The Framingham Omega-3 Index work adds to the case, linking higher omega-3 status to lower all-cause mortality in observational cohorts. But VITAL and ASCEND, two of the biggest trials out there, both showed limited effect on mortality. Moderate benefit. Inconsistent results. That's the grade, and it holds.
Interactions
Additive bleeding risk with anticoagulants and antiplatelets (warfarin, apixaban, clopidogrel, aspirin); high doses may modestly raise LDL-C and, per some trials, atrial fibrillation risk. Discuss with clinician before surgery.
Cautions
Choose products tested for oxidation and heavy-metal/PCB contamination. High-dose (~4 g/day) use should be clinician-supervised. Fish allergy is a consideration; algal oil is a vegetarian alternative.
Food sources
Fatty fish (salmon, mackerel, sardines, herring, anchovies); algal oil provides EPA/DHA for those avoiding fish.
