Risk stratification by the 'EPA+DHA level' and the 'EPA/AA ratio'

This older review proposes a more refined way to read omega-3 status than a single fish-oil number: pairing the total EPA+DHA level with the EPA-to-arachidonic-acid (EPA/AA) ratio as markers of inflammatory and arrhythmic risk.

The authors synthesize evidence linking low EPA+DHA levels and low EPA/AA ratios to higher risk of sudden cardiac death and inflammation, and argue that concentrated ethyl-ester supplements can raise blood levels into a protective range more reliably than diet alone.

The practical takeaway is the idea of measuring and targeting omega-3 status, rather than assuming dietary intake suffices — a precursor to today’s “omega-3 index” concept. The status-quo friction is with dietary purists skeptical of supplementation.

We rate the evidence low: a two-decade-old narrative review proposing novel markers without original data, and modest in scope. Its clinical significance is modest — the EPA+DHA level and EPA/AA ratio remain useful framing for risk stratification, but they never became standard practice, and the broader omega-3 supplementation story has grown more nuanced (and contested) since.