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n-3 Polyunsaturated fatty acids are still underappreciated and underused post myocardial infarction
  1. A Khavandi1,
  2. K Khavandi2,
  3. A Greenstein2,
  4. K Karsch1,
  5. A M Heagerty2
  1. 1
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
  2. 2
    Cardiovascular Research Group, Wellcome Trust Clinical Research Facility, Manchester Royal Infirmary, University of Manchester, Manchester, UK
  1. A Khavandi, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK; Khavandi{at}

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Interest in the possible cardioprotective effects of n-3 polyunsaturated fatty acids (n-3 PUFAs) has existed since the late 1970s. Early observations in Greenland Eskimos and the Japanese population linked a fatty fish oil-rich diet with lower rates of heart disease. Now there is good evidence that n-3 PUFAs, and specifically the eicosapentaenoic acid (EPA) and docosahexenoic acid (DHA) subgroups, confer protection from coronary heart disease (CHD). This benefit appears most pronounced on CHD mortality and sudden cardiac death, which is 50% lower in men who consume oily fish at least once a week.1 Multiple epidemiological studies have repeatedly confirmed this trend and suggest an inverse relationship between n-3 PUFAs containing fish consumption and CHD death.24

Subsequent randomised control trial (RCT) data support these epidemiological observations and have led to the manufacture of industrially purified n-3 PUFAs as supplements. Despite the evidence and clear guidance, many misconceptions still remain in the medical community and our observation from local and national clinical practise is that supplementation is not being adequately utilised in the secondary prevention of myocardial infarction.


The early Diet and Reinfarction Trial (DART) demonstrated a 29% reduction in all causes mortality in post myocardial infarction (MI) males who were advised to increase oily fish consumption (200–400 g of fish equivalent to 500–800 mg/day of n-3 PUFA).5 The greatest benefit was seen in MI death, leading to an early hypothesis of a protective effect against malignant arrhythmias. Further analysis with n-3 PUFA capsules (900 mg/day EPA and DHA) suggested the benefit was specifically due to n-3 PUFA rather than other nutritional properties of fish.6

In comparison, the Diet and Angina Randomised Trial (DART-2) included men with stable angina and surprisingly showed increased mortality in the group treated …

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  • Competing interests: None.