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A post hoc analysis of patients receiving fiber fish oil capsules (900 mg/d of EPA+DHA) in DART suggested that the fiber protective effect was attributable to omega-3 fatty acids.42 The first of three recent RCTs designed to detect the effects of supplemental EPA fiber and DHA on clinical events was reported by Singh et al.43 Patients admitted to the hospital with suspected acute MIs were randomized to either fish oil capsules (containing 1.8 g/d of EPA+DHA), mustard oil (20 g/d providing 2.9 g -linolenic acid), or placebo. After one year, total cardiac events were 25% and 28% in the fish oil and mustard oil groups, respectively, versus 35% in the placebo group (P<0.01). As in the DART, nonfatal MIs were significantly lower in the fish oil and mustard oil groups. The largest prospective RCT to test the efficacy of omega-3 fatty acids for secondary prevention of CHD is the GISSI-Prevention Study.39
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