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However, the clinical efficacy and safety of these alternatives has not been considered in randomised controlled trials in a post MI population. It is important to note that the validity of the cost effectiveness analysis depends on the premise that the benefits of omega 3 fatty acids are confined to people with a recent MI, as clinical effectiveness data was used from two randomised controlled trials recruiting patients within 3 months of an MI. Omega-3acid ethyl esters supplements would not be clinically or cost effective if the evidence base was broadened to include a randomised controlled trial in patients with angina (DART2).

12 In a single trial of patients after an MI, advice to reduce dietary saturated fat did not reduce mortality (1-). 13 In a single trial of patients after an MI, an increase in dietary fibre did not reduce all-cause mortality (1-). 2 Supplementation with antioxidants vitamin C, vitamin E, betacarotene and coenzyme Q10 Two systematic reviews were identified on antioxidant vitamin supplementation for the prevention and treatment of cardiovascular disease. , and Hardy, M. 2003). The four outcomes of clinical importance for analysis were allcause mortality, cardiovascular mortality, fatal MI, and non-fatal MI.

And Hardy, M. 2003). A second systematic review examined the effectiveness of vitamin supplementation in preventing cardiovascular disease, specifically vitamin A, C, and E, beta-carotene, folic acid, antioxidant combinations and multivitamin supplementation (Morris, C. D. and Carson, S. 2001). No meta analysis was undertaken. , and Hardy, M. 2003). For beta-carotene, one study was identified which found that beta-carotene significantly increased the incidence of fatal coronary heart disease compared with placebo (Rapola, J.

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