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Reflections on the Diet and Reinfarction Trial (DART)

M.L. Burr*

Centre for Applied Public Health Medicine, University of Wales College of Medicine, Temple of Peace and Health, Cardiff, U.K.

* Correspondence: Michael L. Burr, Centre for Applied Public Health Medicine, University of Wales College of Medicine, Temple of Peace and Health, Cathays Park, Cardiff CF10 3NW, U.K.

Abstract

The Diet and Reinfarction Trial (DART) was the first randomized controlled trial to test the hypothesis that oily fish confers protection against coronary heart disease. It showed a reduction in mortality during the 2 years after myocardial infarction among men who were advised to eat about 300 g of oily fish per week, or who took fish oil supplements giving an equivalent amount of n-3 fatty acids. These findings have been confirmed by the GISSI-Prevenzione trial, the Lyon Diet Heart Study, and various cohort studies.

Taken together, the evidence suggests that fish oil reduces CHD mortality, the effect being greatest during the period of recovery from acute myocardial infarction. It seems likely that the protection is at least partly attributable to a reduction in the incidence of fatal arrhythmia by n-3 fatty acids. Further research is indicated to investigate this hypothesis.

Randomized controlled trials are particularly important in this connection. Observational studies can supply useful supportive evidence, but they are susceptible to selection bias and can be misleading. There is scope for trials of dietary advice and of nutritional supplements; compliance and indirect effects may well be different, even if the biological mechanisms are the same.

Key Words: Fish oil • coronary heart disease • n-3 fatty acids


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