Adv Nutr, 2014, Volume 5; Pages 863s - 876s.

The evidence for alpha-linolenic acid and cardiovascular disease benefits: Comparisons with eicosapentaenoic acid and docosahexaenoic acid

Fleming, JA. Kris-Etherton, PM.

Key Findings:

This comprehensive review describes the growing evidence supporting an increase in ALA intakes in the diet. The authors provide the rationale for recommendations of 2-3 g/day of ALA to provide benefit for the reduction and treatment of both primary and secondary prevention of CVD. Moreover, they suggest that basis epidemiological findings, ALA may in fact have CVD effects that are similiar to EPA + DHA. They recommend further clinical trials on the effects of ALA on CVD as well as studies to examine both EPA+DHA as well as ALA for heart health. Furthermore they recognize that the science focused on ALA has expanded significantly over the past decade to show the strong beneficial effects of ALA on CVD risk.


Our understanding of the cardiovascular disease (CVD) benefits of alpha-linolenic acid (ALA, 18:3n-3) has advanced markedly during the past decade. It is now evident that ALA benefits CVD risk. The expansion of the ALA evidence base has occurred in parallel with ongoing research on eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) and CVD. The available evidence enables comparisons to be made for ALA vs. EPA + DHA for CVD risk reduction. The epidemiologic evidence suggests comparable benefits of plant-based and marine-derived n-3 (omega-3) PUFAs. The clinical trial evidence for ALA is not as extensive; however, there have been CVD event benefits reported. Those that have been reported for EPA + DHA are stronger because only EPA + DHA differed between the treatment and control groups, whereas in the ALA studies there were diet differences beyond ALA between the treatment and control groups. Despite this, the evidence suggests many comparable CVD benefits of ALA vs. EPA + DHA. Thus, we believe that it is time to revisit what the contemporary dietary recommendation should be for ALA to decrease the risk of CVD. Our perspective is that increasing dietary ALA will decrease CVD risk; however, randomized controlled clinical trials are necessary to confirm this and to determine what the recommendation should be. With a stronger evidence base, the nutrition community will be better positioned to revise the dietary recommendation for ALA for CVD risk reduction. (Authors Abstract)

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