Perspectives on n-3 PUFAs: primary prevention, antiarrhythmic effects, congestive heart failure

The format of the meeting was not planned to produce a formal ‘consensus’ (at least according to the meaning which this term has assumed specifically over the years: a position, or a statement, reached through standardized procedures of confrontation and discussion of evidence, controversial data and opinions, pros and cons). However, the intensive debate which has accompanied all the presentations has suggested and allowed the formulation of a series of statements which could be assumed to represent at least a widely shared background, and which could be used as a baseline for future developments. The points reproduced in Table 1 may be seen as a reasonable summary of the overall philosophy of the meeting and of the issues which have been scored as the most relevant, to be taken into account and to be pursued in future research and developments. There is no doubt that to look, briefly but with very concrete proposals, into the future is a coherent way to conclude a consensus meeting, which was convened around a large population trial. The results of that trial have been specifically instrumental in supporting a substantial change of viewpoint on n-3 PUFAs: from substances acting on the balance of lipids leading to atherosclerotic and thrombotic complications and morbimortality, to drugs which could have its specific target on a more therapeutically ‘orphan’ condition, namely severe arrhythmias leading to sudden death. The physiological and experimental background of this ever-more-clearly emerging profile (which does not eliminate nor contradict the other, mainly epidemiological, documented mechanisms of action and of cardiovascular protection) does not need further comment, following the major contribution proposed by Alexander Leaf. The strength of the hypotheses is further confirmed by the fact that at least two major trials are ongoing on the ‘naturally experimental’ clinical condition represented by patients with implantable cardiac defibrillators (ICD). The experience of the GISSI–Prevenzione trial, with documentation of a remarkable safety record and of a possibly higher then expected tolerability of the much lower dose adopted for a population-wide use, suggests however that there are at least two populations and two objectives which could be targeted to test the broader clinical and epidemiological relevance of n-3 PUFAs: