Fish Oil: What’s in it for me?

In medicine, there has been a huge emphasis in preventative care and this mostly occurs in general practice. Cardiovascular disease is the number one killer in the world, and therefore a disease process we should be trying to prevent with all the tools in our armamentarium. It has been well proven that n-3 fatty acids reduce morbidity and mortality in patients with history of congestive heart failure and myocardial infarction, but what about patients with risk factors for cardiovascular disease that have not had a myocardial infarction?


What they did:
  • Double-blind, placebo-controlled clinical trial
  • 12,505 patients (6239 n-3 fatty acids vs 6266 placebo)
  • Patients with multiple cardiovascular risk factors or cardiovascular disease without history of myocardial infarction
  • Is there benefit of n-3 fatty acids in patients without history of myocardial infarction


Primary Outcomes:

Time to death from cardiovascular causes or admission to the hospital for cardiovascular causes


  • 733/6239 (11.7%) met the primary endpoint in the n-3 fatty acid arm
  • 745/6266 (11.9%) met the primary endpoint in the placebo (olive oil) arm
  • Death at 5 years in n-3 fatty acid arm (2.3%) vs placebo arm (2.2%)


  • None of the results were statistically significant
  • Only Italian population



Patients with multiple cardiovascular risk factors, without history of myocardial infarction, daily treatment with n-3 fatty acids, DOES NOT reduce cardiovascular morbidity and mortality


In my opinion, how this affects your practice:
  • This study had no statistically significant end points
  • The literature is mixed on the cardioprotective effect of n-3 fatty acids
  • To date, there is NO CONCLUSIVE EVIDENCE to recommend fish oil supplementation for primary or secondary prevention of CVD in patients without prior history of myocardial infarction



1. Risk and Prevention Study Collaborative Group et al. n-# Fatty Acids in Patients with Multiple Cardiovascular Risk Factors. NEJM 2013 May; 368: 1800 – 08. PMID: 23656645

2. Roth EM et al. Fish Oil for Primary and Secondary Prevention of Coronary Heart Disease. Curr Atheroscler Rep 2010 Jan; 12 (1): 66 – 72. PMID: 20425273


Dr. Salim R. Rezaie is a physician at the University of Texas Health Science Center at San Antonio. He is double board-certified in Emergency Medicine and Internal Medicine.

About Salim Rezaie

Dr. Rezaie completed his medical school training at Texas A&M Health Science Center, and followed that up with a combined Emergency Medicine/Internal Medicine residency at East Carolina University in Greenville, NC. Currently, he is an attending on the faculty of UTHSCSA in San Antonio, TX, where he focuses on medical education, social media as a tool for education (FOAMed), and building the bridges between internal medicine, critical care, and emergency medicine. Feel free to contact him on Twitter (@srrezaie) (@UTHSCSAPearls) about anything EM/IM! Salim Rezaie
May 24, 2013

I can see this new research changing the practice of many internists and cardiologists. I am very passionate about preventive health and see it as the essence of outpatient medicine. However, it appears that in our constant search for the next “magic pill” (e.g. fish oil, niacin) we often overlook the power of the triad of diet, exercise, and weight loss. Those interventions and smoking cessation (if applicable) should be the top priority when attempting to reduce cardiovascular morbidity and mortality. My approach is to use it universally for all patients, with or without risk factors.

May 24, 2013

Hello again Ravi,
I agree….far and away the triad of exercise, diet, and weight loss should be the priority of preventative medicine for cardiovascular disease. The “magic pill” does not exist….good old fashioned hard work and self control is what is needed to accomplish these things. Thank you again for reading this and would love to see if others have an opinion about fish oil use.


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