Fish oils and vascular disease prevention: an update.

Considerable epidemiological data confirmed the existence of favorable associations between fish consumption and mortality from cardiovascular disease. Accumulating evidence suggests that n-3 polyunsaturated fatty acids supplementation is an effective additive treatment for the primary and secondary prevention of cardiovascular disease. Another indication for the use of n-3 PUFA is the treatment of hypertriglyceridemia as monotherapy or in combination with other lipid lowering agents (e.g. statins or fibrates). However, high doses of n-3 PUFA are required for this effect (e.g. 3-4 g/day). Fish oils may be acting via several mechanisms that include antiarrhythmic, antithrombotic and anti-inflammatory effects as well as plaque stabilization. Despite the current evidence supporting a beneficial effect of fish oils on vascular disease, more definitive studies than the ones already performed are required. Some ongoing trials may provide further insight into the indications for fish oil supplementation. This review considers the mechanisms accounting for the cardioprotective properties of n-3 polyunsaturated fatty acids. We also discuss the epidemiological and interventional studies evaluating the relationship between n-3 polyunsaturated fatty acids consumption and cardiovascular disease.