Fish oil in primary and secondary cardiovascular prevention

Omega-3 fatty acid therapy shows great promise in both primary and secondary prevention of cardiovascular (CV) diseases, especially coronary heart disease (CHD). In this review, we discuss the evidence available from prospective and retrospective observational epidemiologic studies and controlled clinical trials demonstrating the effects of omega-3 fatty acids (fish oil) in primary and especially secondary prevention of major CV events, including CV mortality, fatal and nonfatal myocardial infarction (MI), and sudden cardiac death (SCD). Significant reductions in total mortality and SCD to the extent of 20% to 50% have been found in studies using doses ranging from 0.85 to 4.0 g/d. We review the compelling evidence that indicates all clinicians should strongly consider therapy with fish oil, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), for patients with known CV disease and for patients at increased risk for CV disease, particularly patients at increased risk for SCD. The target DHA + EPA consumption levels are about 800 to 1000 mg/d for individuals with known CHD and at least 500 mg/d for individuals without disease.