Fish oil and secondary prevention of cardiovascular diseaseBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2541 (Published 24 December 2008) Cite this as: BMJ 2008;337:a2541
- Eric Brunner, reader in epidemiology and coeditor, Cochrane Heart Group1,
- Hiroyasu Iso, professor and head2
- 1Department of Epidemiology and Public Health, UCL Medical School, London WC1E 6BT
- 2Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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 …