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The specific effects on different CVD outcomes (especially MI and stroke) are uncertain. ahrq In addition, the studies were heterogeneous with regard to the methods of estimating fish or omega-3 fatty acid intake, background diets, background risk for heart disease, settings, and the methods of reporting ahrq results. For these reasons, the validity of applying the results of studies conducted in countries outside of the United States to the U.S. population is uncertain. Moreover, dietary intervention trials, such as DART,38 the Lyon Heart,11 and the ahrq Indian Experiment of Infarct Survival,12 are limited by multiple and complex dietary changes in the trials that do not permit easy differentiation among components and make it difficult to determine which specific components or combinations of these diets are most beneficial. Furthermore, the optimal quantity and type of omega-3 fatty acid, and the optimal ratio of omega-3 to omega-6 fatty acid, if any, still remain undefined.
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