Cardiovascular benefit of long chain n-3 fatty acids - The evidence gets stronger

There is substantial evidence from epidemiologic studies that consumption of fish, especially oily fish, and of long chain n-3 polyunsaturated fatty acids (PUFAs) lowers risk of cardiovascular mortality. A protective effect on fatal myocardial infarction and, especially, sudden death has been widely reported. Secondary prevention studies using modest doses of n-3 PUFAs to patients who had survived a myocardial infarction demonstrate significant benefit in mortality reduction, again particularly so from sudden death. N-3 PUFAs beneficially alter several cardiovascular risk factors including blood pressure and plasma triacylglycerol concentrations and they reduce atherosclerosis in animals. Whilst these effects may contribute to the overall reduction in cardiovascular mortality, they are not likely to contribute to the reduction in sudden death. Here, the anti-thrombotic and anti-arrhythmic effects of n-3 PUFAs are considered to be important. A recent study has highlighted another potential mechanism by which n-3 PUFAs might decrease the risk of cardiovascular events. This study showed that n-3 PUFAs from fish oil are incorporated into advanced atherosclerotic plaques and are associated with lower macrophage infiltration and with a morphology that is indicative of increased plaque stability. This is important because it is the considered that the vulnerability of atherosclerotic plaques to rupture rather than the degree of atherosclerosis is the primary determinant of thrombosis-mediated acute cardiovascular events