Current Atherosclerosis Reports

, Volume 10, Issue 6, pp 510–517

Omega-3 fatty acids: How can they be used in secondary prevention?

  • Konstantinos Tziomalos
  • Vasilios G. Athyros
  • Asterios Karagiannis
  • Dimitri P. Mikhailidis


Omega-3 fatty acids (FAs) are divided into long-chain fatty acids (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]), which are found in fatty fish, and intermediate-chain FAs (α-linolenic acid), which are found in vegetable oils. Omega-3 FAs favorably modulate a variety of vascular risk factors and also exert antiarrhythmic effects. Epidemiologic data suggest that increased consumption of marine omega-3 FAs is associated with reduced coronary heart disease (CHD) mortality. Randomized controlled studies also show that supplementation with EPA and DHA reduces CHD risk, primarily in the secondary prevention setting. Data are more limited on the efficacy of marine omega-3 FAs for the primary prevention of CHD and on the role of α-linolenic acid. Increased intake of EPA and DHA represents a valuable tool for vascular disease prevention and should be recommended in all patients with CHD.


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References and Recommended Reading

  1. 1.
    De Caterina R, Madonna R, Bertolotto A, Schmidt EB: n-3 fatty acids in the treatment of diabetic patients: biological rationale and clinical data. Diabetes Care 2007, 30:1012–1026.PubMedCrossRefGoogle Scholar
  2. 2.
    Breslow JL: n-3 fatty acids and cardiovascular disease. Am J Clin Nutr 2006, 83:1477S–1482S.PubMedGoogle Scholar
  3. 3.
    He K, Song Y, Daviglus ML, et al.: Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation 2004, 109:2705–2711.PubMedCrossRefGoogle Scholar
  4. 4.
    Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet 1999, 354:447–455.Google Scholar
  5. 5.
    Yokoyama M, Origasa H, Matsuzaki M, et al.: Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007, 369:1090–1098.PubMedCrossRefGoogle Scholar
  6. 6.
    Bays H: Clinical overview of Omacor: a concentrated formulation of omega-3 polyunsaturated fatty acids. Am J Cardiol 2006, 98:71i–76i.PubMedCrossRefGoogle Scholar
  7. 7.
    Hill AM, Buckley JD, Murphy KJ, Howe PR: Combining fish-oil supplements with regular aerobic exercise improves body composition and cardiovascular disease risk factors. Am J Clin Nutr 2007, 85:1267–1274.PubMedGoogle Scholar
  8. 8.
    Nilsen DW, Albrektsen G, Landmark K, et al.: Effects of a high-dose concentrate of n-3 fatty acids or corn oil introduced early after an acute myocardial infarction on serum triacylglycerol and HDL cholesterol. Am J Clin Nutr 2001, 74:50–56.PubMedGoogle Scholar
  9. 9.
    Hjerkinn EM, Seljeflot I, Ellingsen I, et al.: Influence of long-term intervention with dietary counseling, long-chain n-3 fatty acid supplements, or both on circulating markers of endothelial activation in men with long-standing hyperlipidemia. Am J Clin Nutr 2005, 81:583–589.PubMedGoogle Scholar
  10. 10.
    Johansen O, Brekke M, Seljeflot I, et al.: N-3 fatty acids do not prevent restenosis after coronary angioplasty: results from the CART study. Coronary Angioplasty Restenosis Trial. J Am Coll Cardiol 1999, 33:1619–1626.PubMedCrossRefGoogle Scholar
  11. 11.
    Kelley DS, Siegel D, Vemuri M, Mackey BE: Docosahexaenoic acid supplementation improves fasting and postprandial lipid profiles in hypertriglyceridemic men. Am J Clin Nutr 2007, 86:324–333.PubMedGoogle Scholar
  12. 12.
    Satoh N, Shimatsu A, Kotani K, et al.: Purified eicosapentaenoic acid reduces small dense LDL, remnant lipoprotein particles, and C-reactive protein in metabolic syndrome. Diabetes Care 2007, 30:144–146.PubMedCrossRefGoogle Scholar
  13. 13.
    Gazi IF, Tsimihodimos V, Tselepis AD, et al.: Clinical importance and therapeutic modulation of small dense low-density lipoprotein particles. Expert Opin Biol Ther 2007, 7:53–72.PubMedCrossRefGoogle Scholar
  14. 14.
    Abe Y, El Masri B, Kimball KT, et al.: Soluble cell adhesion molecules in hypertriglyceridemia and potential significance on monocyte adhesion. Arterioscler Thromb Vasc Biol 1998, 18:723–731.PubMedGoogle Scholar
  15. 15.
    Chan DC, Watts GF, Barrett PH, et al.: Effect of atorvastatin and fish oil on plasma high-sensitivity C-reactive protein concentrations in individuals with visceral obesity. Clin Chem 2002, 48:877–883.PubMedGoogle Scholar
  16. 16.
    Madden J, Brunner A, Dastur ND, et al.: Fish oil induced increase in walking distance, but not ankle brachial pressure index, in peripheral arterial disease is dependent on both body mass index and inflammatory genotype. Prostagland Leukot Essent Fatty Acids 2007, 76:331–340.CrossRefGoogle Scholar
  17. 17.
    Geleijnse JM, Giltay EJ, Grobbee DE, et al.: Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens 2002, 20:1493–1499.PubMedCrossRefGoogle Scholar
  18. 18.
    Khan F, Elherik K, Bolton-Smith C, et al.: The effects of dietary fatty acid supplementation on endothelial function and vascular tone in healthy subjects. Cardiovasc Res 2003, 59:955–962.PubMedCrossRefGoogle Scholar
  19. 19.
    Nestel P, Shige H, Pomeroy S, et al.: The n-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid increase systemic arterial compliance in humans. Am J Clin Nutr 2002, 76:326–330.PubMedGoogle Scholar
  20. 20.
    Mita T, Watada H, Ogihara T, et al.: Eicosapentaenoic acid reduces the progression of carotid intima-media thickness in patients with type 2 diabetes. Atherosclerosis 2007, 191:162–167.PubMedCrossRefGoogle Scholar
  21. 21.
    Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP: Endothelial function, arterial stiffness and lipid lowering drugs. Expert Opin Ther Targets 2007, 11:1143–1160.PubMedCrossRefGoogle Scholar
  22. 22.
    Thies F, Garry JM, Yaqoob P, et al.: Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controlled trial. Lancet 2003, 361:477–485.PubMedCrossRefGoogle Scholar
  23. 23.
    Nalsen C, Vessby B, Berglund L, et al.: Dietary (n-3) fatty acids reduce plasma F2-isoprostanes but not prostaglandin F2alpha in healthy humans. J Nutr 2006, 136:1222–1228.PubMedGoogle Scholar
  24. 24.
    Higgins S, Carroll YL, McCarthy SN, et al.: Susceptibility of LDL to oxidative modification in healthy volunteers supplemented with low doses of n-3 polyunsaturated fatty acids. Br J Nutr 2001, 85:23–31.PubMedCrossRefGoogle Scholar
  25. 25.
    Lauretani F, Semba RD, Bandinelli S, et al.: Plasma polyunsaturated fatty acids and the decline of renal function. Clin Chem 2008, 54:475–481.PubMedCrossRefGoogle Scholar
  26. 26.
    Efstratiadis G, Tziomalos K, Mikhailidis DP, et al.: Atherogenesis in renal patients: a model of vascular disease? Curr Vasc Pharmacol 2008, 6:93–107.PubMedCrossRefGoogle Scholar
  27. 27.
    Lee KW, Lip GY: Effects of lifestyle on hemostasis, fibrinolysis, and platelet reactivity: a systematic review. Arch Intern Med 2003, 163:2368–2392.PubMedCrossRefGoogle Scholar
  28. 28.
    Toft I, Bonaa KH, Ingebretsen OC, et al.: Fibrinolytic function after dietary supplementation with omega3 polyunsaturated fatty acids. Arterioscler Thromb Vasc Biol 1997, 17:814–819.PubMedGoogle Scholar
  29. 29.
    Zhao G, Etherton TD, Martin KR, et al.: Dietary alphalinolenic acid reduces inflammatory and lipid cardiovascular risk factors in hypercholesterolemic men and women. J Nutr 2004, 134:2991–2997.PubMedGoogle Scholar
  30. 30.
    Bloedon LT, Balikai S, Chittams J, et al.: Flaxseed and cardiovascular risk factors: results from a double blind, randomized, controlled clinical trial. J Am Coll Nutr 2008, 27:65–74.PubMedGoogle Scholar
  31. 31.
    Paschos GK, Yiannakouris N, Rallidis LS, et al.: Apolipoprotein E genotype in dyslipidemic patients and response of blood lipids and inflammatory markers to alpha-linolenic acid. Angiology 2005, 56:49–60.PubMedCrossRefGoogle Scholar
  32. 32.
    Harper CR, Edwards MC, Jacobson TA: Flaxseed oil supplementation does not affect plasma lipoprotein concentration or particle size in human subjects. J Nutr 2006, 136:2844–2848.PubMedGoogle Scholar
  33. 33.
    Bemelmans WJ, Broer J, Feskens EJ, et al.: Effect of an increased intake of alpha-linolenic acid and group nutritional education on cardiovascular risk factors: the Mediterranean Alpha-linolenic Enriched Groningen Dietary Intervention (MARGARIN) study. Am J Clin Nutr 2002, 75:221–227.PubMedGoogle Scholar
  34. 34.
    Wendland E, Farmer A, Glasziou P, Neil A: Effect of alpha linolenic acid on cardiovascular risk markers: a systematic review. Heart 2006, 92:166–169.PubMedCrossRefGoogle Scholar
  35. 35.
    Bemelmans WJ, Lefrandt JD, Feskens EJ, et al.: Increased alpha-linolenic acid intake lowers C-reactive protein, but has no effect on markers of atherosclerosis. Eur J Clin Nutr 2004, 58:1083–1089.PubMedCrossRefGoogle Scholar
  36. 36.
    Djousse L, Arnett DK, Pankow JS, et al.: Dietary linolenic acid is associated with a lower prevalence of hypertension in the NHLBI Family Heart Study. Hypertension 2005, 45:368–373.PubMedCrossRefGoogle Scholar
  37. 37.
    Nestel PJ, Pomeroy SE, Sasahara T, et al.: Arterial compliance in obese subjects is improved with dietary plant n-3 fatty acid from flaxseed oil despite increased LDL oxidizability. Arterioscler Thromb Vasc Biol 1997, 17:1163–1170.PubMedGoogle Scholar
  38. 38.
    Li D, Sinclair A, Wilson A, et al.: Effect of dietary alpha-linolenic acid on thrombotic risk factors in vegetarian men. Am J Clin Nutr 1999, 69:872–882.PubMedGoogle Scholar
  39. 39.
    Mozaffarian D, Lemaitre RN, Kuller LH, et al.: Cardiac benefits of fish consumption may depend on the type of fish meal consumed: the Cardiovascular Health Study. Circulation 2003, 107:1372–1377.PubMedCrossRefGoogle Scholar
  40. 40.
    Daviglus ML, Stamler J, Orencia AJ, et al.: Fish consumption and the 30-year risk of fatal myocardial infarction. N Engl J Med 1997, 336:1046–1053.PubMedCrossRefGoogle Scholar
  41. 41.
    Albert CM, Campos H, Stampfer MJ, et al.: Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002, 346:1113–1118.PubMedCrossRefGoogle Scholar
  42. 42.
    London B, Albert C, Anderson ME, et al.: Omega-3 fatty acids and cardiac arrhythmias: prior studies and recommendations for future research: a report from the National Heart, Lung, and Blood Institute and Office Of Dietary Supplements Omega-3 Fatty Acids and their Role in Cardiac Arrhythmogenesis Workshop. Circulation 2007, 116:e320–e335.PubMedCrossRefGoogle Scholar
  43. 43.
    Montanez A, Ruskin JN, Hebert PR, et al.: Prolonged QTc interval and risks of total and cardiovascular mortality and sudden death in the general population: a review and qualitative overview of the prospective cohort studies. Arch Intern Med 2004, 164:943–948.PubMedCrossRefGoogle Scholar
  44. 44.
    Mozaffarian D, Prineas RJ, Stein PK, Siscovick DS: Dietary fish and n-3 fatty acid intake and cardiac electrocardiographic parameters in humans. J Am Coll Cardiol 2006, 48:478–484.PubMedCrossRefGoogle Scholar
  45. 45.
    Geelen A, Brouwer IA, Zock PL, et al.: (N-3) fatty acids do not affect electrocardiographic characteristics of healthy men and women. J Nutr 2002, 132:3051–3054.PubMedGoogle Scholar
  46. 46.
    Geelen A, Zock PL, Brouwer IA, et al.: Effect of n-3 fatty acids from fish on electrocardiographic characteristics in patients with frequent premature ventricular complexes. Br J Nutr 2005, 93:787–790.PubMedCrossRefGoogle Scholar
  47. 47.
    Jouven X, Empana JP, Schwartz PJ, et al.: Heart-rate profile during exercise as a predictor of sudden death. N Engl J Med 2005, 352:1951–1958.PubMedCrossRefGoogle Scholar
  48. 48.
    Mozaffarian D, Geelen A, Brouwer IA, et al.: Effect of fish oil on heart rate in humans: a meta-analysis of randomized controlled trials. Circulation 2005, 112:1945–1952.PubMedCrossRefGoogle Scholar
  49. 49.
    Mozaffarian D, Stein PK, Prineas RJ, Siscovick DS: Dietary fish and omega-3 fatty acid consumption and heart rate variability in US adults. Circulation 2008, 117:1130–1137.PubMedCrossRefGoogle Scholar
  50. 50.
    Dekker JM, Crow RS, Folsom AR, et al.: Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis Risk In Communities. Circulation 2000, 102:1239–1244.PubMedGoogle Scholar
  51. 51.
    Christensen JH, Korup E, Aaroe J, et al.: Fish consumption, n-3 fatty acids in cell membranes, and heart rate variability in survivors of myocardial infarction with left ventricular dysfunction. Am J Cardiol 1997, 79:1670–1673.PubMedCrossRefGoogle Scholar
  52. 52.
    Christensen JH, Gustenhoff P, Korup E, et al.: Effect of fish oil on heart rate variability in survivors of myocardial infarction: a double blind randomised controlled trial. BMJ 1996, 312:677–678.PubMedGoogle Scholar
  53. 53.
    O’Keefe JH Jr, Abuissa H, Sastre A, et al.: Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions. Am J Cardiol 2006, 97:1127–1130.PubMedCrossRefGoogle Scholar
  54. 54.
    Christensen JH, Riahi S, Schmidt EB, et al.: n-3 Fatty acids and ventricular arrhythmias in patients with ischaemic heart disease and implantable cardioverter defibrillators. Europace 2005, 7:338–344.PubMedCrossRefGoogle Scholar
  55. 55.
    Raitt MH, Connor WE, Morris C, et al.: Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial. JAMA 2005, 293:2884–2891.PubMedCrossRefGoogle Scholar
  56. 56.
    Brouwer IA, Zock PL, Camm AJ, et al.: Effect of fish oil on ventricular tachyarrhythmia and death in patients with implantable cardioverter defibrillators: the Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) randomized trial. JAMA 2006, 295:2613–2619.PubMedCrossRefGoogle Scholar
  57. 57.
    Leaf A, Albert CM, Josephson M, et al.: Prevention of fatal arrhythmias in high-risk subjects by fish oil n-3 fatty acid intake. Circulation 2005, 112:2762–2768.PubMedCrossRefGoogle Scholar
  58. 58.
    Albert CM, Oh K, Whang W, et al.: Dietary alpha-linolenic acid intake and risk of sudden cardiac death and coronary heart disease. Circulation 2005, 112:3232–3238.PubMedCrossRefGoogle Scholar
  59. 59.
    Djousse L, Rautaharju PM, Hopkins PN, et al.: Dietary linolenic acid and adjusted QT and JT intervals in the National Heart, Lung, and Blood Institute Family Heart study. J Am Coll Cardiol 2005, 45:1716–1722.PubMedCrossRefGoogle Scholar
  60. 60.
    Bucher HC, Hengstler P, Schindler C, Meier G: N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med 2002, 112:298–304.PubMedCrossRefGoogle Scholar
  61. 61.
    Erkkila AT, Matthan NR, Herrington DM, Lichtenstein AH: Higher plasma docosahexaenoic acid is associated with reduced progression of coronary atherosclerosis in women with CAD. J Lipid Res 2006, 47:2814–2819.PubMedCrossRefGoogle Scholar
  62. 62.
    Sacks FM, Stone PH, Gibson CM, et al.: Controlled trial of fish oil for regression of human coronary atherosclerosis. HARP Research Group. J Am Coll Cardiol 1995, 25:1492–1498.PubMedCrossRefGoogle Scholar
  63. 63.
    von Schacky C, Angerer P, Kothny W, et al.: The effect of dietary omega-3 fatty acids on coronary atherosclerosis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1999, 130:554–562.Google Scholar
  64. 64.
    Angerer P, Kothny W, Stork S, von Schacky C: Effect of dietary supplementation with omega-3 fatty acids on progression of atherosclerosis in carotid arteries. Cardiovasc Res 2002, 54:183–190.PubMedCrossRefGoogle Scholar
  65. 65.
    Eritsland J, Arnesen H, Gronseth K, et al.: Effect of dietary supplementation with n-3 fatty acids on coronary artery bypass graft patency. Am J Cardiol 1996, 77:31–36.PubMedCrossRefGoogle Scholar
  66. 66.
    Bairati I, Roy L, Meyer F: Double-blind, randomized, controlled trial of fish oil supplements in prevention of recurrence of stenosis after coronary angioplasty. Circulation 1992, 85:950–956.PubMedGoogle Scholar
  67. 67.
    Dehmer GJ, Popma JJ, van den Berg EK, et al.: Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n-3 fatty acids. N Engl J Med 1988, 319:733–740.PubMedCrossRefGoogle Scholar
  68. 68.
    Cairns JA, Gill J, Morton B, et al.: Fish oils and low-molecular-weight heparin for the reduction of restenosis after percutaneous transluminal coronary angioplasty. The EMPAR Study. Circulation 1996, 94:1553–1560.PubMedGoogle Scholar
  69. 69.
    Djousse L, Folsom AR, Province MA, et al.: Dietary linolenic acid and carotid atherosclerosis: the National Heart, Lung, and Blood Institute Family Heart Study. Am J Clin Nutr 2003, 77:819–825.PubMedGoogle Scholar
  70. 70.
    Djousse L, Arnett DK, Carr JJ, et al.: Dietary linolenic acid is inversely associated with calcified atherosclerotic plaque in the coronary arteries: the National Heart, Lung, and Blood Institute Family Heart Study. Circulation 2005, 111:2921–2926.PubMedCrossRefGoogle Scholar
  71. 71.
    Pedersen JI, Ringstad J, Almendingen K, et al.: Adipose tissue fatty acids and risk of myocardial infarction—a case-control study. Eur J Clin Nutr 2000, 54:618–625.PubMedCrossRefGoogle Scholar
  72. 72.
    Simon JA, Hodgkins ML, Browner WS, et al.: Serum fatty acids and the risk of coronary heart disease. Am J Epidemiol 1995, 142:469–476.PubMedGoogle Scholar
  73. 73.
    Guallar E, Aro A, Jimenez FJ, et al.: Omega-3 fatty acids in adipose tissue and risk of myocardial infarction: the EURAMIC study. Arterioscler Thromb Vasc Biol 1999, 19:1111–1118.PubMedGoogle Scholar
  74. 74.
    Tziomalos K, Athyros VG, Mikhailidis DP: Fish oils and vascular disease prevention: an update. Curr Med Chem 2007, 14:2622–2628.PubMedCrossRefGoogle Scholar
  75. 75.
    Wang C, Harris WS, Chung M, et al.: n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary-and secondary-prevention studies: a systematic review. Am J Clin Nutr 2006, 84:5–17.PubMedGoogle Scholar
  76. 76.
    Iso H, Kobayashi M, Ishihara J, et al.: Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I. Circulation 2006, 113:195–202.PubMedCrossRefGoogle Scholar
  77. 77.
    Erkkila AT, Lehto S, Pyorala K, Uusitupa MI: n-3 Fatty acids and 5-y risks of death and cardiovascular disease events in patients with coronary artery disease. Am J Clin Nutr 2003, 78:65–71.PubMedGoogle Scholar
  78. 78.
    Burr ML, Fehily AM, Gilbert JF, et al.: Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet And Reinfarction Trial (DART). Lancet 1989, 2:757–761.PubMedCrossRefGoogle Scholar
  79. 79.
    Marchioli R, Barzi F, Bomba E, et al.: Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation 2002, 105:1897–1903.PubMedCrossRefGoogle Scholar
  80. 80.
    Singh RB, Niaz MA, Sharma JP, et al.: Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival-4. Cardiovasc Drugs Ther 1997, 11:485–491.PubMedCrossRefGoogle Scholar
  81. 81.
    Svensson M, Schmidt EB, Jorgensen KA, Christensen JH: N-3 fatty acids as secondary prevention against cardiovascular events in patients who undergo chronic hemodialysis: a randomized, placebo-controlled intervention trial. Clin J Am Soc Nephrol 2006, 1:780–786.PubMedCrossRefGoogle Scholar
  82. 82.
    Burr ML, Ashfield-Watt PA, Dunstan FD, et al.: Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr 2003, 57:193–200.PubMedCrossRefGoogle Scholar
  83. 83.
    de Lorgeril M, Renaud S, Mamelle N, et al.: Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994, 343:1454–1459.PubMedCrossRefGoogle Scholar
  84. 84.
    de Lorgeril M, Salen P, Martin JL, et al.: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999, 99:779–785.PubMedGoogle Scholar
  85. 85.
    Hooper L, Thompson RL, Harrison RA, et al.: Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ 2006, 332:752–760.PubMedCrossRefGoogle Scholar
  86. 86.
    He K, Song Y, Daviglus ML, et al.: Fish consumption and incidence of stroke: a meta-analysis of cohort studies. Stroke 2004, 35:1538–1542.PubMedCrossRefGoogle Scholar
  87. 87.
    Sommerfield T, Price J, Hiatt WR: Omega-3 fatty acids for intermittent claudication. Cochrane Database Syst Rev 2007, CD003833.Google Scholar
  88. 88.
    Kris-Etherton PM, Harris WS, Appel LJ: Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002, 106:2747–2757.PubMedCrossRefGoogle Scholar
  89. 89.
    Lichtenstein AH, Appel LJ, Brands M, et al.: Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006, 114:82–96.PubMedCrossRefGoogle Scholar
  90. 90.
    Smith SC Jr, Allen J, Blair SN, et al.: AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006, 113:2363–2372.PubMedCrossRefGoogle Scholar
  91. 91.
    Zipes DP, Camm AJ, Borggrefe M, et al.: ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006, 48:e247–e346.PubMedCrossRefGoogle Scholar
  92. 92.
    Guallar E, Sanz-Gallardo MI, van’t Veer P, et al.: Mercury, fish oils, and the risk of myocardial infarction. N Engl J Med 2002, 347:1747–1754.PubMedCrossRefGoogle Scholar
  93. 93.
    Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002, 106:3143–3421.Google Scholar
  94. 94.
    Oh RC, Beresford SA, Lafferty WE: The fish in secondary prevention of heart disease (FISH) survey—primary care physicians and omega3 fatty acid prescribing behaviors. J Am Board Fam Med 2006, 19:459–467.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  • Konstantinos Tziomalos
    • 1
  • Vasilios G. Athyros
  • Asterios Karagiannis
  • Dimitri P. Mikhailidis
  1. 1.Second Propedeutic Department of Internal MedicineAristotle University, Hippokration HospitalThessalonikiGreece

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