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Prevention of Non Communicable Diseases

Fish intake and risk of cardiovascular events: an analysis of the VITAL cohort



Dietary habits with fish consumption have been associated with a lower risk of cardiovascular (CV) disease, based on heterogenous observational studies. Current recommendations suggest eating at least 1–2 fish servings per week for CV prevention.


We conducted a retrospective evaluation of a cohort study that enrolled a large primary prevention population to determine the potential benefit of fish intake ≥1.5 serving per week, through a multivariate Cox regression model. The outcomes of interest included all-cause mortality, cardiovascular mortality, MACE (composite endpoint of myocardial infarction, stroke, and death from cardiovascular causes), expanded MACE (MACE plus coronary revascularization), total myocardial infarction (MI), total coronary heart disease (CHD) and total stoke. The estimates were reported using hazard ratio (HR) with 99% confidence intervals (99% CI).


A total of 25,435 patients were evaluated (11,921 individuals ≥1.5 fish servings/week; 13,514 < 1.5 fish servings per week). Intake ≥1.5 servings/week was not independently associated with CV outcomes reduction, such as CV mortality, MI risk MACE, expanded MACE outcomes, CHD or stroke (HR 0.78, 99% CI 0.57–1.07).


Fish intake ≥1.5 servings/week was not associated with CV outcomes improvement in this analysis, but potential benefit cannot be ruled out.

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The datasets analyzed during the current study were provided by Project Data Sphere (PDS) (


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DC was responsible for the conceptualization, methodology, data curation, formal analysis, Writing - Original Draft, visualization, Writing - Review & Editing and supervision. BNG was involved in Writing - Original Draft and Writing - Review & Editing. AA and FJP were involved in Writing - Review & Editing.

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Correspondence to Daniel Caldeira.

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Caldeira, D., Nogueira-Garcia, B., Abreu, A. et al. Fish intake and risk of cardiovascular events: an analysis of the VITAL cohort. Eur J Clin Nutr 77, 400–404 (2023).

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