The Role of Long-Chained Marine N-3 Polyunsaturated Fatty Acids in Cardiovascular Disease

Table 3

Official recommendations for the use of marine n-3 fatty acids in CVD prevention.

	Primary prevention	Secondary prevention
The American Heart Association (AHA)^1	Eat a variety of fish, preferably oily fish (salmon, tuna, mackerel, herring, and trout), at least twice a week. Consuming fish oil supplements should only be considered by people with high levels of triglycerides who consult with their physicians.	Consume about 1 gram per day of the fish oils EPA and DHA (eicosapentaenoic and docosahexaenoic acids), preferably from oily fish, although EPA + DHA supplements could be considered in consultation with their physicians.; People who have elevated triglycerides may need two to four grams of EPA and DHA per day provided as capsules under a physician’s care.
European Society of Cardiology (ESC)	Eat fish twice a week, of which once oily fish^2.; The recommended doses of total EPA and DHA to lower triglycerides have varied between 2 and 4 g/day. Use of n-3 fatty acids (prescription products) as an adjunct to the diet if triglycerides exceed 5.6 mmol/L (496 mg/dL)^3.	Eat fish twice a week, of which once oily fish^2.; The recommended doses of total EPA and DHA to lower triglycerides have varied between 2 and 4 g/day. Use of n-3 fatty acids (prescription products) as an adjunct to the diet if triglycerides exceed 5.6 mmol/L (496 mg/dL)^3.
American College of Cardiology (ACC)	No recommendation.	Encourages increased consumption of omega-3 fatty acids in the form of fish or in capsule form (1 g/d) for risk reduction. For treatment of elevated triglycerides, higher doses are usually necessary for risk reduction^4.
International Society for the Study of Fatty Acids and Lipids (ISSFAL)^5	A minimum intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined, of 500 mg/d.	No recommendation.
Scientific Advisory Committee on Nutrition, United Kingdom; (UK SACN)^6	Recommends the equivalent of 450 mg marine omega-3 daily and an increase in population oily fish consumption to one portion a week.	Recommends the equivalent of 450 mg marine omega-3 daily and an increase in population oily fish consumption to one portion a week.
World Health Organization (WHO)^7	Regular fish consumption (1-2 servings per week) is protective against coronary heart disease and ischaemic stroke and is recommended. The serving should provide an equivalent of 200–500 mg of eicosapentaenoic and docosahexaenoic acid.	Regular fish consumption (1-2 servings per week) is protective against coronary heart disease and ischaemic stroke and is recommended. The serving should provide an equivalent of 200–500 mg of eicosapentaenoic and docosahexaenoic acid.

¹http://www.heart.org/.
²European Guidelines on cardiovascular disease prevention in clincal practice (version 2012). The fifth joint task.
Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. EHJ 2012; 33: 1635-1701.
³ESC/EAS Guidelines for the management of dyslipidaemia. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). EHJ 2011; 32(14): 1769-1818.
⁴AHA/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. JACC 2006; 47(10): 2130-9.
⁵http://www.issfal.org/.
⁶Advice on Fish Consumption: Benefits and Risks was published in 2004 by the joint SACN/COT Subgroup (SACN 2004).
⁷World Health Organization (WHO) 2003: “Diet, Nutrition and the Prevention of Chronic Diseases.”