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Life sciences · Journal article
Journal of Clinical Lipidology · August 1, 2026
Encouraging direction, but not yet definitive.
This RCT demonstrates that high-dose EPA+DHA fish oil supplementation combined with a structured cardioprotective diet significantly reduces the CERT2 lipidomic risk score in adults with increased cardiometabolic risk over 20 weeks, with a sustained but attenuated effect at 40 weeks. The effect is statistically significant but based on a surrogate biomarker rather than clinical events; confirmation in larger populations and with hard outcomes is needed.
Randomized, parallel-group, controlled dietary intervention trial. Adults aged 20–80 years with LDL-C ≥3.0 mmol/L, not receiving lipid-lowering medication, at increased cardiometabolic risk in a primary prevention setting.. Intervention: Personalised cardioprotective menu plans plus 3 g/day EPA+DHA (long-chain n-3 polyunsaturated fatty acids). Compared with: Personalised cardioprotective menu plans alone (no fish oil supplementation).
MP-FO group showed significantly greater CERT2 score reduction than MP group at Week 10: -2.44 (95% CI -3.42 to -1.47) CERT2 reduction sustained at Week 20: -2.18 (95% CI -3.15 to -1.21) in MP-FO versus MP Effect attenuated but remained significant at 40-week follow-up: -1.63 (95% CI -2.61 to -0.65)
No clinical hard endpoints (myocardial infarction, stroke, mortality) reported; CERT2 is a surrogate biomarker.
Clinicians should note that fish oil supplementation appears to favourably modify a novel lipidomic risk score beyond standard lipid measures in primary prevention. However, the lack of hard clinical outcome data and the surrogate nature of the endpoint mean this finding should inform further research rather than immediate practice change; confirmation with cardiovascular events is essential.
A well-designed 20-week RCT with a responsive surrogate biomarker endpoint (CERT2 score) showing statistically significant reductions with fish oil plus diet, but lacking hard clinical outcomes and requiring confirmation in larger populations.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should note that fish oil supplementation appears to favourably modify a novel lipidomic risk score beyond standard lipid measures in primary prevention. However, the lack of hard clinical outcome data and the surrogate nature of the endpoint mean this finding should inform further research rather than immediate practice change; confirmation with cardiovascular events is essential.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background Ceramides and phosphatidylcholines, key components of the Coronary Event Risk Test 2 (CERT2), are strong predictors of cardiovascular events beyond low-density lipoprotein cholesterol (LDL-C). Whether dietary strategies targeting lipidomic risk profiles can modify these biomarkers remains insufficiently explored. Objective To investigate whether long-chain n-3 polyunsaturated fatty acid supplementation, within a structured cardioprotective dietary programme, modifies ceramide- and phosphatidylcholine-associated cardiovascular risk in adults at increased cardiometabolic risk in a primary prevention setting. Methods The MoKaRi trial was a 20-week, randomised, parallel-group dietary intervention followed by a 20-week follow-up. Adults aged 20–80 years with LDL-C ≥3.0 mmol/L, not receiving lipid-lowering medication, were included. Participants received either personalised cardioprotective menu plans (MP) or identical menu plans supplemented with 3 g/day EPA+DHA (MP-FO). The exploratory endpoint was the change in the CERT2 risk score following the dietary intervention. Results The MP-FO group demonstrated significantly greater reductions in the CERT2 score throughout the 20-week intervention when compared to the MP group (Week 10: -2.44, 95% CI -3.42 to -1.47; Week 20: -2.18, 95% CI -3.15 to -1.21). Although the effect attenuated after 40 weeks, it remained significant (-1.63, 95% CI -2.61 to -0.65). Only the fish-oil–supplemented group displayed favourable changes in ceramide–phosphatidylcholine ratios. Conclusions High-dose EPA+DHA supplementation embedded in a structured heart-healthy diet reduces CERT2 in adults with increased cardiometabolic risk, indicating that this lipidomic risk score is modifiable by nutritional intervention. CERT2 may therefore serve as a responsive biomarker for monitoring improvements in cardiovascular risk beyond LDL-C in preventive cardiology.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.