Editorials

Fish oil and secondary prevention of cardiovascular disease

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2541 (Published 24 December 2008) Cite this as: BMJ 2008;337:a2541

This article has a correction. Please see:

  1. Eric Brunner, reader in epidemiology and coeditor, Cochrane Heart Group1,
  2. Hiroyasu Iso, professor and head2
  1. 1Department of Epidemiology and Public Health, UCL Medical School, London WC1E 6BT
  2. 2Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  1. eric.brunner{at}uclmail.net

    On the basis of current evidence, the mechanism and size of any effect is uncertain

    The National Institute for Health and Clinical Excellence recommends that after a myocardial infarction patients should eat two to four portions of oily fish a week. People who are not willing or able to do this may be prescribed omega 3 acid ethyl esters, which are licensed in the United Kingdom and Japan for patients who have had a myocardial infarction. The aim is to achieve a daily intake of 1 g of long chain polyunsaturated fish oil and thereby to reduce the risk of death or further non-fatal cardiovascular events.

    In the NICE review, evidence for the benefit of purified fish oils in this patient group was provided by one large trial completed a decade ago.1 GISSI (Gruppo Italiano per la Sperimentazione della Streptochinasi nell’Infarto Miocardico) found substantial reductions in total mortality and mortality from cardiovascular disease but not in non-fatal cardiovascular events. Important questions remained. Were the findings reproducible? Is it eicosapentanenoic acid, docosahexaenoic acid, or the combination of both that protects against …

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