Omega-3 fatty acids and coronary heart disease. The final verdict?

The fish fatty acids eicosapentenoic acid (EPA) and docosahexenoic acid (DHA) may be protective against fatal coronary heart disease (CHD) and sudden cardiac death. This review summarizes the recent findings of prospective cohort studies and randomized controlled trials.

A recently published meta-analysis of 17 prospective cohort studies showed that eating fish once a week compared to eating less fish was associated with a 16% lower risk of fatal CHD. Epidemiologic studies with cardiac arrest or sudden cardiac death as endpoint observed also an inverse relation with fish consumption. In contrast, a recently published meta-analysis of 14 randomized, double-blind, placebo-controlled trials in cardiovascular patients did not show a protective effect of an additional amount of EPA-DHA on fatal CHD and sudden cardiac death. Subgroup analyses suggested that this could be because of a low absolute risk as a consequence of the state-of-the-art drug treatment.

Eating fatty fish once or lean fish twice a week is recommended for both primary and secondary prevention of CHD. A definite statement cannot be made about the dosage of EPA-DHA required for secondary prevention of CHD.