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The 39 studies included 12 RCTs, 22 prospective cohort studies of at least 1 year in duration, 4 herring case-control studies, and 1 cross-sectional study. All herring of these studies quantified or estimated the intake of fish or omega-3 fatty acids (including fish oil or ALA supplements) and assessed the effects of their consumption on CVD outcomes in the general (primary prevention) or CVD (secondary prevention) populations. Secondary prevention studies We reviewed 11 RCTs and one prospective cohort study that reported outcomes on CVD populations. Together, the trials herring included over 16,000 patients and each lasted between 1.5 to 5 years. Four trials used fish oil (EPA+DHA) supplements in a dosage that ranged from 0.27 to 4.8 g/d.5-8 The methodological quality was generally good. The largest trial5 reported that fish oil (EPA + DHA) reduces all-cause mortality and CVD outcomes but does not affect stroke. Other trials that evaluated fish oil supplements reported similar results on CVD and stroke outcomes.
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