Preventive Use Of N-3 Fatty Acids

To the Editor: In the editorial “N-3 fatty acids: priority for post–myocardial infarction clinical trials,” Dr Scott Grundy1 (somewhat cautiously) endorsed the need for a trial to test the hypothesis that ω-3 fatty acid (FA) supplements will reduce risk for coronary death in patients randomized in the immediate post–myocardial infarction period. We support this recommendation, but we differ with Dr Grundy’s assessment of the strength of the evidence for recommending increased intake of eicosapentaenoic and docosahexaenoic acids (EPA and DHA) today. The GISSI Prevenzione study, although not placebo-controlled (blinding ω-3 FA capsules is not easy), did, however, provide compelling evidence from a randomized trial of 11 000 postinfarction patients that 850 mg of these two FA will reduce total mortality by 28% ( P <0.03) and risk for sudden death by 47% ( P =0.01).2 This appears to be due to a unique ability of ω-3 fats to reduce fatal ventricular arrhythmias that are independent …