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Prevention of Non Communicable Diseases

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

Abstract

Background

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.

Methods

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).

Results

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).

Conclusion

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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Fig. 1
Fig. 2

Data availability

The datasets analyzed during the current study were provided by Project Data Sphere (PDS) (https://doi.org/10.34949/n4c7-zm25).

References

  1. World Health Organization. WHO reveals leading causes of death and disability worldwide: 2000-19. World Health Organization; Geneva, Switzerland, 2020.

  2. Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1923–94.

    Article  Google Scholar 

  3. Yu E, Malik VS, Hu FB. Cardiovascular disease prevention by diet modification: JACC health promotion series. J Am Coll Cardiol. 2018;72:914–26.

    Article  Google Scholar 

  4. Newman WP, Middaugh JP, Propst MT, Rogers DR. Atherosclerosis in Alaska Natives and non-natives. Lancet. 1993;341:1056-7.

  5. Kromann NGA. Epidemiological studies in Upernavik District, Greenland. Acta Med Scand. 1980;208:401–6.

    Article  CAS  Google Scholar 

  6. Bang H, Dyerberg J, Nielsen A. Plasma lipidi and lipoprotein pattern in greenlandic west-coast eskimos. Lancet. 1971. https://doi.org/10.1016/S0140-6736(71)91658-8.

  7. Zheng J, Huang T, Yu Y, Hu X, Yang B, Li D. Fish consumption and CHD mortality: an updated meta-analysis of seventeen cohort studies. Public Health Nutr. 2012;15:725–37.

    Article  Google Scholar 

  8. de la Guía-Galipienso F, Martínez-Ferran M, Vallecillo N, Lavie CJ, Sanchis-Gomar F, Pareja-Galeano H. Vitamin D and cardiovascular health. Clin Nutr. 2021;40:2946–57.

    Article  Google Scholar 

  9. Shalihat A, Hasanah AN, Mutakin, Lesmana R, Budiman A, Gozali D. The role of selenium in cell survival and its correlation with protective effects against cardiovascular disease: a literature review. Biomed Pharmacother. 2021;134. https://doi.org/10.1016/j.biopha.2020.111125.

  10. Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. https://jamanetwork.com/.

  11. He K, Song Y, Daviglus ML, Liu K, van Horn L, Dyer AR, et al. Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation. 2004;109:2705–11.

    Article  Google Scholar 

  12. Whelton SP, He J, Whelton PK, Muntner P. Meta-analysis of observational studies on fish intake and coronary heart disease. Am J Cardiol. 2004;93:1119–23.

    Article  Google Scholar 

  13. Estruch R, Sacanella E, Ros E. Should we all go pesco-vegetarian? Eur Heart J. 2021;42:1144–6.

    Article  Google Scholar 

  14. Rimm EB, Appel LJ, Chiuve SE, Djoussé L, Engler MB, Kris-Etherton PM, et al. Seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease: a science advisory from the American Heart Association. Circulation. 2018;138:e35–e47.

    Article  CAS  Google Scholar 

  15. Manson JE, Cook NR, Lee I-M, Christen W, Bassuk SS, Mora S, et al. Marine n−3 fatty acids and prevention of cardiovascular disease and cancer. N Engl J Med. 2019;380:23–32.

    Article  CAS  Google Scholar 

  16. Manson JE, Cook NR, Lee I-M, Christen W, Bassuk SS, Mora S, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med. 2019;380:33–44.

    Article  CAS  Google Scholar 

  17. Bassuk SS, Manson JE, Lee I-M, Cook NR, Christen WG, Bubes VY, et al. Baseline characteristics of participants in the VITamin D and OmegA-3 TriaL (VITAL). Contemp Clin Trials. 2016;47:235–43.

    Article  Google Scholar 

  18. Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol. 1992;135:1114–26.

    Article  CAS  Google Scholar 

  19. Feskanich D, Rimm EB, Giovannucci EL, Colditz GA, Stampfer MJ, Litin LB, et al. Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. J Am Diet Assoc. 1993;93:790–6.

    Article  CAS  Google Scholar 

  20. Hunter DJ, Rimm EB, Sacks FM, Stampfer MJ, Colditz GA, Litin LB, et al. Comparison of measures of fatty acid intake by subcutaneous fat aspirate, food frequency questionnaire, and diet records in a free-living population of US men. Am J Epidemiol. 1992;135:418–27.

    Article  CAS  Google Scholar 

  21. Gammelmark A, Nielsen MS, Bork CS, Lundbye-Christensen S, Tjønneland A, Overvad K, et al. Association of fish consumption and dietary intake of marine n-3 PUFA with myocardial infarction in a prospective Danish cohort study. Br J Nutr. 2016;116:167–77.

    Article  CAS  Google Scholar 

  22. Albert CM, Hennekens CH, O’Donnell CJ, Ajani UA, Carey VJ, Willett WC, et al. Fish consumption and risk of sudden cardiac death. JAMA. 1998;279:23–8.

    Article  CAS  Google Scholar 

  23. Jayedi A, Zargar MS, Shab-Bidar S. Fish consumption and risk of myocardial infarction: a systematic review and dose-response meta-analysis suggests a regional difference. Nutr Res. 2019;62:1–12.

    Article  CAS  Google Scholar 

  24. Kris-Etherton PM, Harris WS, Appel LJ. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106:2747–57.

    Article  Google Scholar 

  25. Saravanan P, Davidson NC, Schmidt EB, Calder PC. Cardiovascular effects of marine omega-3 fatty acids. Lancet. 2010;375:540–50.

    Article  Google Scholar 

  26. Harris W. N-3 Fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 1997. https://doi.org/10.1093/ajcn/65.5.1645S.

  27. Harris WS, Miller M, Tighe AP, Davidson MH, Schaefer EJ. Omega-3 fatty acids and coronary heart disease risk: Clinical and mechanistic perspectives. Atherosclerosis. 2008;197:12–24.

    Article  CAS  Google Scholar 

  28. Mori TA, Woodman RJ. The independent effects of eicosapentaenoic acid and docosahexaenoic acid on cardiovascular risk factors in humans. Curr Opin Clin Nutr Metab Care. 2006;9:95–104.

  29. Hegele RA, Ginsberg HN, Chapman MJ, Nordestgaard BG, Kuivenhoven JA, Averna M, et al. The polygenic nature of hypertriglyceridaemia: implications for definition, diagnosis, and management. Lancet Diabetes Endocrinol. 2014;2:655–66.

    Article  CAS  Google Scholar 

  30. Abdelhamid AS, Martin N, Bridges C, Brainard JS, Wang X, Brown TJ et al. Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018. https://doi.org/10.1002/14651858.cd012345.pub3.

  31. Morris MC, Sacks F, Rosner B. Does fish oil lower blood pressure? A meta-analysis of controlled trials. http://ahajournals.org.

  32. Yamagata K. Prevention of endothelial dysfunction and cardiovascular disease by n-3 fatty acids-inhibiting action on oxidative stress and inflammation. Curr Pharm Des. 2020;26:3652–66.

    Article  CAS  Google Scholar 

  33. Mori TA, Beilin LJ. Omega-3 fatty acids and inflammation. Curr Atheroscler Rep. 2004;6:461–7.

    Article  Google Scholar 

  34. Goel A, Pothineni N, Singhal M, Paydak H, Saldeen T, Mehta J. Fish, Fish Oils and Cardioprotection: Promise or Fish Tale? Int J Mol Sci. 2018;19:3703.

    Article  Google Scholar 

  35. Emerging Risk Factors Collaboration, Kaptoge S, di Angelantonio E, Lowe G, Pepys MB, Thompson SG, et al. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet. 2010;375:132–40.

    Article  Google Scholar 

  36. Emerging Risk Factors Collaboration, Kaptoge S, di Angelantonio E, Pennells L, Wood AM, White IR, et al. C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med. 2012;367:1310–20.

    Article  Google Scholar 

  37. Ridker PM, Everett BM, Thuren T, MacFadyen JG, Chang WH, Ballantyne C, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377:1119–31.

    Article  CAS  Google Scholar 

  38. Abrantes AM, Nogueira-Garcia B, Alves M, Teixeira Passos D, Brito D, Pinto FJ et al. Low-dose colchicine in coronary artery disease—systematic review and meta-analysis. Circ Rep. 2021;3: CR-21-0065.

  39. Marchioli R, Barzi F, Bomba E, Chieffo C, di Gregorio D, di Mascio R, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction. Circulation. 2002;105:1897–903.

    Article  CAS  Google Scholar 

  40. DiNicolantonio JJ, OKeefe J. The benefits of marine omega-3s for preventing arrhythmias. Open Heart. 2020;7:e000904.

    Article  Google Scholar 

  41. Khoueiry G, Abi Rafeh N, Sullivan E, Saiful F, Jaffery Z, Kenigsberg DN, et al. Do omega-3 polyunsaturated fatty acids reduce risk of sudden cardiac death and ventricular arrhythmias? A meta-analysis of randomized trials. Heart Lung. 2013;42:251–6.

    Article  Google Scholar 

  42. Sheikh O, vande Hei AG, Battisha A, Hammad T, Pham S, Chilton R. Cardiovascular, electrophysiologic, and hematologic effects of omega-3 fatty acids beyond reducing hypertriglyceridemia: as it pertains to the recently published REDUCE-IT trial. Cardiovasc Diabetol. 2019;18:84.

    Article  Google Scholar 

  43. Mohan D, Mente A, Dehghan M, Rangarajan S, O’Donnell M, Hu W, et al. Associations of fish consumption with risk of cardiovascular disease and mortality among individuals with or without vascular disease from 58 countries. JAMA Intern Med. 2021;181:631.

    Article  Google Scholar 

  44. Bjerregaard L, Joensen A, Dethlesfsen C, Jensen M, Johnsen S, Tjonneland A, et al. Fish intake and acute coronary syndrome. Eur Heart J. 2009;31:15–16.

    Google Scholar 

  45. Zhang B, Xiong K, Cai J, Ma A. Fish consumption and coronary heart disease: a meta-analysis. Nutrients. 2020;12:2278.

    Article  Google Scholar 

  46. Rajaram S, Haddad EH, Mejia A, Sabaté J. Walnuts and fatty fish influence different serum lipid fractions in normal to mildly hyperlipidemic individuals: a randomized controlled study. Am J Clin Nutr. 2009;89:1657S–1663S.

    Article  CAS  Google Scholar 

  47. Raatz SK, Johnson LK, Rosenberger TA, Picklo MJ. Twice weekly intake of farmed Atlantic salmon (Salmo salar) positively influences lipoprotein concentration and particle size in overweight men and women. Nutr Res. 2016;36:899–906.

    Article  CAS  Google Scholar 

  48. Chen C, Yu X, Shao S. Effects of omega-3 fatty acid supplementation on glucose control and lipid levels in type 2 diabetes: a meta-analysis. PLoS One. 2015;10:e0139565.

    Article  Google Scholar 

  49. Wallin A, di Giuseppe D, Orsini N, Patel PS, Forouhi NG, Wolk A. Fish consumption, dietary long-chain n-3 fatty acids, and risk of type 2 diabetes. Diabetes Care. 2012;35:918–29.

    Article  CAS  Google Scholar 

  50. Karlström BE, Järvi AE, Byberg L, Berglund LG, Vessby BO. Fatty fish in the diet of patients with type 2 diabetes: comparison of the metabolic effects of foods rich in n–3 and n–6 fatty acids. Am J Clin Nutr. 2011;94:26–33.

    Article  Google Scholar 

  51. Kotwal S, Jun M, Sullivan D, Perkovic V, Neal B. Omega 3 fatty acids and cardiovascular outcomes: systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012;5:808–18.

    Article  Google Scholar 

  52. Hu Y, Hu FB, Manson JAE. Marine omega-3 supplementation and cardiovascular disease: an updated meta-analysis of 13 randomized controlled trials involving 127 477 participants. J Am Heart Assoc. 2019;8. https://doi.org/10.1161/JAHA.119.013543.

  53. Yusuf PS, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.

    Article  Google Scholar 

  54. O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388:761–75.

    Article  Google Scholar 

  55. Daan Kromhout EBBC de LC. The inverse relationship between fish consumption and CHD. N Engl J Med. 1985; 312:1205–9.

  56. Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events a systematic review and meta-analysis. http://jama.jamanetwork.com/.

  57. Aung T, Halsey J, Kromhout D, Gerstein HC, Marchioli R, Tavazzi L, et al. Associations of omega-3 fatty acid supplement use with cardiovascular disease risks meta-analysis of 10 trials involving 77 917 individuals. JAMA Cardiol. 2018;3:225–34.

    Article  Google Scholar 

  58. ASCEND Study Collaborative Group, Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, Barton J, et al. Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus. N Engl J Med. 2018;379:1540–1550.

  59. Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380:11–22.

    Article  CAS  Google Scholar 

  60. Nicholls SJ, Lincoff AM, Garcia M, Bash D, Ballantyne CM, Barter PJ, et al. Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the STRENGTH randomized clinical trial. JAMA J Am Med Assoc. 2020;324:2268–80.

    Article  CAS  Google Scholar 

  61. Leung K, Galano J-M, Durand T, Lee J. Profiling of omega-polyunsaturated fatty acids and their oxidized products in salmon after different cooking methods. Antioxidants. 2018;7:96.

    Article  Google Scholar 

  62. Mekonnen MF, Desta DT, Alemayehu FR, Kelikay GN, Daba AK. Evaluation of fatty acid‐related nutritional quality indices in fried and raw nile tilapia, (Oreochromis Niloticus), fish muscles. Food Sci Nutr. 2020;8:4814–21.

    Article  CAS  Google Scholar 

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Acknowledgements

This publication is based on research using information obtained from www.projectdatasphere.org, which is maintained by Project Data Sphere. Neither Project Data Sphere nor the owners of any information from the web site have contributed to, approved or are in any way responsible for the contents of this publication.

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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 (2022). https://doi.org/10.1038/s41430-022-01244-w

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