The southeastern United States, known as the “stroke belt,” has long been associated with higher rates of heart attacks and strokes compared to the rest of the country. Now, new research published in Prostaglandins, Leukotrienes and Essential Fatty Acids highlights another critical factor at play: remarkably low omega-3 blood levels in people living in this region.
What Is the Omega-3 Index?
The Omega-3 Index is a blood test that measures the percentage of two key omega-3 fatty acids—EPA and DHA—within red blood cell membranes.
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4% or below = undesirable (linked with higher risk of sudden cardiac death)
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8–12% = desirable (associated with better heart health outcomes)
Studies have consistently shown that a higher Omega-3 Index correlates with reduced risk of cardiovascular disease (CVD) and sudden cardiac events.
Stroke Belt States and Cardiovascular Risk
The stroke belt generally includes:
Alabama, Arkansas, Florida, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, Ohio, Oklahoma, South Carolina, and Tennessee.
Since the 1960s, CDC data show that residents of these states are almost twice as likely to experience a stroke compared to the national average. This elevated risk has largely been attributed to the Southern Dietary Pattern—a diet rich in fried foods, processed meats, saturated fats, and sugary beverages, and low in nutrient-dense foods. This pattern not only raises the risk of stroke but also contributes to higher rates of obesity, hypertension, and diabetes.
Omega-3 Index Results in Stroke Belt Cities
To better understand omega-3 status in this region, researchers tested the Omega-3 Index of 2,177 people across seven stroke belt cities, including Charleston (WV), Jacksonville (FL), Indianapolis (IN), Lexington (KY), Memphis (TN), Oklahoma City (OK), and Toledo (OH).
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42% of participants had an Omega-3 Index below 4% (linked to 90% higher risk of sudden cardiac death).
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Only 1% of participants reached the desirable range of 8% or above.
According to Dr. Bill Harris, lead author of the study:
“Since in other settings, a low Omega-3 Index is associated with increased risk for cardiovascular disease, this may be one factor contributing to the higher risk for CVD in this region of the US.”
Comparing the Stroke Belt to the General U.S. Population
When compared to broader U.S. data, the findings were striking:
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Only 1.2% of individuals in the SNP (Seafood Nutrition Partnership) cohort reached the desirable range, compared to 7% in a national dataset.
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42% had undesirable levels (<4%), compared to 35% nationwide.
This suggests that low omega-3 status is disproportionately affecting stroke belt residents.
Raising Omega-3 Levels: A Preventive Strategy
Researchers emphasized that increasing EPA and DHA intake—through both diet and supplementation—could help reduce cardiovascular risk in this vulnerable population.
Options for Raising Omega-3 Intake:
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Fatty fish (salmon, sardines, mackerel, herring, albacore tuna)
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Fish oil supplements delivering adequate EPA + DHA
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Fortified foods (eggs, juices, milk, bread, spreads, nut butters enriched with omega-3s)
Proper nutrition education and community outreach could play a vital role in improving omega-3 intake in stroke belt regions.
Supporting Evidence from Other Studies
Additional research strengthens the case for omega-3s in heart protection:
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NIH-AARP Diet & Health Study: High non-fried fish intake was linked to lower mortality from Alzheimer’s, CVD, cancer, and respiratory disease.
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MESA Study: Higher plasma EPA levels were associated with reduced risk of heart failure in more than 6,500 participants over 13 years.
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Major Clinical Trials (2018):
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28% reduction in heart attacks with 840 mg EPA+DHA/day for over 5 years
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19% reduction in vascular death in type 2 diabetes patients
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REDUCE-IT trial: 25% reduction in CVD events with 4 g/day of EPA in statin-treated patients
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Final Thoughts
The stroke belt continues to face disproportionately high rates of stroke and cardiovascular disease, and this new research suggests low omega-3 status is a significant contributing factor.
Improving omega-3 intake—whether through fatty fish, supplements, or fortified foods—offers a safe, affordable, and evidence-backed strategy to help reduce cardiovascular risk in this region.
As Dr. Harris concludes:
“There is accumulating evidence that higher intakes of fish and omega-3 capsules (both of which increase the Omega-3 Index) are good for the heart.”