Dietary n-3 fatty acid intake and risk of sudden death and coronary artery disease

Opinion statement Based upon the data from observational epidemiologic studies and randomized clinical trials that are summarized in this article, as well as plausible mechanisms for benefit, the American Heart Association and several international health agencies recommend that all adults eat fish, particularly fatty fish, at least two times per week to lower risk of coronary heart disease (CHD). Patients with established CHD are advised to consume 1 g/d of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined. However, many individuals may find it difficult to consume 1 g/d of EPA and DHA, which translates into several meals of fish per week. Thus, fish oil in the form of supplements may be a preferable way to achieve compliance with these recommendations. Because only one large-scale secondary-prevention randomized trial of n-3 fatty acid supplements has been published to date, fish oil supplements have not been routinely recommended after myocardial infarction (MI). However, based upon the present evidence, this treatment option could be considered as one possible avenue to decrease risk of sudden cardiac death (SCD) in the early post-MI period when implantable cardioverter-defibrillator (ICD) therapy appears to be less efficacious. n-3 Fatty acid supplements are currently not indicated for prevention of recurrent ventricular arrhythmias in patients with ICDs due to the conflicting and primarily null randomized trial results in this patient population. Finally, based upon the current state of evidence, it is unclear whether dietary intake of α-linolenic acid (ALA), a plant-based intermediate-chain n-3 fatty acid, influences risk of CHD or SCD. Therefore, increasing intake of ALA specifically for the prevention of CHD cannot be recommended at this time.