Omega-3 supplements vs fatty fish — which is better for heart health?

Same active compounds (EPA/DHA), but the evidence quality differs in an interesting way. Omega-3 supplements have genuinely split cardiovascular evidence: a Cochrane review found little to no clear benefit, while a separate, larger meta-analysis of 13 trials covering over 127,000 participants found modest real reductions in cardiovascular events — the disagreement mostly comes down to which trials and doses each review emphasized. Fatty fish, the whole-food source, scores higher on real-world impact here: meta-analyses link higher fish intake or blood omega-3 levels to lower cardiovascular disease risk somewhat more consistently. Neither is dramatically superior, but if you can eat fatty fish regularly, the evidence for getting your omega-3s that way is at least as strong as the supplement — with the added nutritional benefits of the food itself.