BACKGROUND: In 2008, the Heart Foundation published a Position Statement and supporting documents that recommended marine n-3 omega fatty acids (Eicosapentaenoic (EPA) and Docosahexaenoic (DHA)) in all patients with coronary disease and set targets of intake for asymptomatic individuals. Since the publication new relevant trials have been completed and published and other groups around the world have made recommendations.

METHODS: Review of published articles regarding marine n-3 fatty acids and review of guidelines of other national bodies such as the National Institute of Health and Clinical Excellence (NICE) and the European Society of Cardiology.

RESULTS: Since the Heart Foundation review, two major outcome trials have been completed. An unpublished underpowered post-infarction trial from Germany involved 1000 individuals for 12 months was negative. In contrast, a published adequately powered outcome trial of 6975 patients with heart failure were randomised in 2x2 factorial design that compared Rosuvastatin or placebo and in addition one daily capsule of 1 g n-3 PUFA (850-882 mg Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) as ethyl esters in the average ratio of EPA/DHA 1:1.2) or matching placebo and followed up for 3.9 years. The Omega 3 ethyl ester was associated with a 2% absolute risk reduction of total mortality (P=0.04) and all pre-specified subgroups showed decrease in cardiovascular death and admission to hospital with heart failure.

CONCLUSION: The Heart Foundation recommendations that all patients with cardiovascular disease ought to have at least 1 gram of combined EPA/DHA per day has been reinforced by further clinical trials and is consistent with recommendation of the American College of Cardiology, NICE and the European Society of Cardiology. There is now compelling evidence that this dose improves cardiovascular outcomes significantly on the background of standard therapy.