During the last decades progress has been made in the treatment of patients who survived myocardial infarction. Nevertheless, patients who survive an acute myocardial infarction are at high risk, with life expectancy half that of their peers who have not experienced similar events, and with increased risk for subsequent cardiovascular events and death. The risk of sudden death increases with severity of systolic dysfunction after myocardial infarction. In recent years, it has become clear that in addition to risk factors such as overweight, lack of exercise, smoking, hypertension and hypercholesterolemia, psychosocial factors play a key role for prognosis in patients with myocardial infarction. Therefore, there is high medical need for drugs which lower the incidence of sudden death and have an effect on other risk factors such as depression. OMACOR®, a pharmaceutical preparation of highly purified and concentrated Ω-3 polyunsaturated acids, may present such a drug. It lowers the incidence of sudden death in patients with myocardial infarction and decreases depression. This publication focuses on the effect of Ω-3 polyunsaturated fatty acids on different risk factors in patients with cardiovascular disease. In addition, aspects of prevention of cardiovascular disease, risk factors and pharmacokinetics of Ω-3 fatty acids ethyl esters are considered.