Eicosapentaenoic acid (EPA) from highly concentrated n-3 fatty acid ethyl esters is incorporated into advanced atherosclerotic plaques and higher plaque EPA is associated with decreased plaque inflammation and increased stability.


Since the early 1970s when Bang and Dyerberg observed an ssociation between fish consumption (mainly seal andwhale) and educed morbidity and mortality from cardiovascular diseases in reenlanders [1,2], a vast amount of research has been carried out, ncluding clinical trials with various end points of the disease, as ell as metabolic studies, investigating possible mechanisms for hese protective effects. Major clinical trials investigating the effects of fish oils, namely icosapentaenoic (EPA) and docosahexaenoic (DHA) acids on moridity and mortality rates from cardiovascular diseases in the econdary prevention include the DART, the GISSI Prevenzione and he JELIS trials and they all showed beneficial effects. In a more ecent trial, the GISSI-HF, it was also found that 1 g of n-3 PUFA per ay had beneficial effects onmortality and on admission to hospital or cardiovascular reasons in patients with heart failure [3]. On the ther hand, DART II failed to show similar effects but there were ome methodological problems in this trial. Finally, another study, he Omega Trial, which was reported at the American College of ardiology meeting in 2009, looked at the effects of 1 g of fish oils er day on sudden cardiac death (primary endpoint) and on total eath, reinfarction, stroke, arrhythmia and revascularization (secndary endpoints) [4]. None of the endpoints were met but again his study was time driven and not event driven and to the best of y knowledge, it has not been published yet. Several mechanisms have been proposed for the influence f EPA and DHA on cardiovascular disease risk. These include ntiarrhythmic, hypotriglyceridemic, anti-thrombotic and antinflammatory effects as well as increased size of LDL particles lthough a small increase of LDL cholesterol levels may also be bserved. In a recent review article, it was emphasized that the


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