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Eleven heart healthy food RCTs and one prospective cohort study reported outcomes heart healthy food on CVD populations. The largest trial reported that fish oil reduces all-cause mortality and CVD events, although fish oil has no heart healthy food effect on stroke. In the only RCT that directly compared alpha-linoleic acid (ALA) and fish oil, both treatments were comparable in effectiveness in improving CVD outcome. Twenty-two prospective cohort studies, differing considerably in the populations used and estimated omega-3 intake, and one RCT reported data on general populations. Most of the large cohort studies found fish consumption was associated with lower rates of all-cause mortality and CVD outcomes, but several studies reported either no significant or negative results for the CVD outcomes. Conclusions: Overall, consumption of omega-3 fatty acids, whether from fish or from supplements, reduces all-cause mortality and improves various CVD outcomes. The evidence for benefit from ALA supplements is sparse and inconclusive.
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