Coronary heart disease (CHD) is a globally common cardiovascular disorder, characterized by atherosclerotic lesions in the coronary arteries, leading to narrowing or blockage of the vessels, which subsequently causes myocardial ischemia, hypoxia, and even necrosis. This condition significantly impacts the daily life of patients and represents a major contributor to both morbidity and mortality on a global scale. Omega-3 polyunsaturated fatty acids (ω-3 PUFA), Principally extracted from marine pisces and certain plants, have been increasingly shown in recent years to be closely associated with various pathophysiological mechanisms related to CHD, which holds significant value in the prevention and treatment of CHD. This review offers a comprehensive summary of the sources of ω-3 PUFA, explores the pathophysiological mechanisms of CHD, and offers an in-depth analysis of the multifaceted contribution of ω-3 PUFA in mitigating the susceptibility to CHD, particularly focusing on their effects on lipid metabolism, endothelial function, and inflammatory pathways, thereby contributing new research perspectives for the tactics for the risk mitigation and administration of CHD, including both preventive measures and therapeutic interventions.