Epidemiological studies as well as randomised dietary trials suggest that Mediterranean diet may be important in relation to the pathogenesis and prevention of coronary heart disease (CHD). A striking protective effect of a Mediterranean diet rich in alpha-linolenic acid (ALA) was reported in the Lyon Diet Heart Study with a 50 to 70% reduction of the risk of recurrence after four years of follow-up in CHD patients. According to current knowledge, dietary ALA should represent about 0.6 to 1% of total daily energy or about 2 g per day in patients who follow a traditional Mediterranean diet. Supplementation with very long chain omega-3 fatty acids (c.1g per day) in patients following a Mediterranean type of diet was shown to decrease the risk of cardiac death by 30% and of sudden cardiac death by 45% in the GISSI trial. Thus, in the context of a diet rich in oleic acid, poor in saturated fats and not high in omega-6 fatty acids (a dietary pattern characterizing the traditional Mediterranean diet), even a small dose of very long chain omega-3 fatty acids (one gram under the form of capsules) might be very protective. These data underline the importance of the accompanying diet in any dietary strategy using fatty acid complements.