In Eskimos living their traditional lifestyle the diet is high in (marine) fat yet CHD appeared uncommon. Bang and Dyerberg made successive summer visits to a community in Greenland. They confirmed that in these Eskimos CHD was rare, plasma cholesterols were relatively low, triglycerides very low. Seal, whale and fish predominated in the diet. The Eskimo plasma lipids had high saturated fatty acids, very low linoleic and linolenic and exceptionally high eicosapentaenoic acid (EPA; 20:5 ω-3). EPA reduces platelet aggregation.
In other populations Kromhout first reported that fish consumption appears to protect against CHD in a Dutch cohort (1985). Then in Adelaide (Australia) animal experiments (1985–1993) showed that prior feeding fish oil prevented ventricular fibrillation that often follows coronary ischaemia. A secondary prevention trial in Italy (1999) found that on EPA + DHA (22:6) there was significantly lower mortality (notably fewer sudden deaths). Fatty fish or fish oil (or EPA produced microbiologically) were added to the list of recommended foods. Years 1971, 1985, 1999.