Polyunsaturated fatty acids in cardiovascular diseases: uncertainty prevails.

In the late 1970s, a lower incidence of myocardial infarction and favorable hemostatic alterations were reported in Greenland Inuits. This observation prompted investigators worldwide to continue research on the role of a specific diet in this population and sparked an ongoing discussion about the potential use of polyunsaturated fatty acids (PUFAs) in the primary prevention of cardiovascular disease (VITAL), and the secondary prevention of primarily coronary artery disease (JELIS, REDUCE‑IT, OMEMI). However, the current evidence to support the preventive value of PUFAs is inconsistent. Seminal clinical trials such as the GISSI‑Prevenzione, JELIS, PREDIMED, or ASCEND differed in their approach to the assessment of cardiovascular effects of n-3 PUFAs and reported divergent results. The questions remain whether eicosapentaenoic acid is the only PUFA offering cardiovascular benefits, what is the importance of PUFA dosing, and, finally, who should receive n-3 PUFA treatment. This article discusses the latest insights into n-3 PUFA use in cardiovascular disease prevention.