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Secondary cardiovascular disease prevention (fish oil / EPA plus DHA)
Several well-conducted randomized controlled trials report that in people with a history of heart attack, regular consumption of oily fish (200-400 grams of fish each week equal to 500-800mg of daily omega-3 fatty acids) or fish oil/omega-3 supplements (containing 850-1800mg of EPA + DHA) reduces the risk of non-fatal heart attack, fatal heart attack, sudden death, and all-cause mortality (death due to any cause) (11;14-19). Most patients in these studies were also using conventional heart drugs, suggesting that the benefits of fish oils may add to the effects of other therapies. Benefits have been reported after 3 months of use, and after up to 3.5 years of follow-up. Benefits of supplements may not occur in populations that already consume large amounts of dietary fish (20).Multiple mechanisms have been proposed for the beneficial effects of omega-3 fatty acids. These include reduced triglyceride levels, reduced inflammation, slightly lowered blood pressure, reduced blood clotting, reduced tendency of the heart to develop abnormal rhythms, and diminished buildup of atherosclerotic plaques in arteries of the heart. Experiments suggest that omega-3 fatty acids may reduce platelet derived growth factor (PDGF), decrease platelet aggregation, inhibit the expression of vascular adhesion molecules, and stimulate relaxation of endothelial cells in the walls of blood vessels (21).The American Heart Association, in its 2003 recommendations, suggests that people with known coronary heart disease take in approximately 1 gram of EPA and DHA (combined) each day (11). This may be obtained from eating fish, or from fish oil capsule supplements. Because of the risk of bleeding from omega-3 fatty acids (particularly at doses greater than 3 grams per day), a physician should be consulted prior to starting treatment with supplements.