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In another study, Hu et al. stratified the omega-6/omega-3 ratio into two groups (low ratio omega 9fatty acid group, median = 5.9; high ratio group, median = 9.2) and compared the effect of increasing amounts of omega-3 omega 9fatty acid fatty omega 9fatty acid acids (ALA, EPA, DHA). They reported that the inverse association with risk of CVD appeared to be somewhat stronger in the high ratio group compared to the low-ratio group, but a test for interaction was not statistically significant.29 CVD question 2c. Question 2c. asks how the efficacy or association of omega-3 fatty acids on CVD events differs by source (e.g., dietary fish, dietary oils, dietary plants, fish oil supplement, and flax seed supplement). To address this question, we needed to compare the efficacy of different sources of omega-3 fatty acids; however, the available studies were too heterogeneous in terms of study design, duration, background diet, methods of assessment, and outcomes to allow even indirect comparisons that were meaningful.
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