Eating Fish Tied to Fewer CVD Events in High-Risk People
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People with cardiovascular disease (CVD) who regularly ate fish had significantly fewer major CVD events and there were fewer total deaths compared with similar individuals who didn't eat fish, but there was no beneficial link from eating fish among the general population in prospective data collected from more than 191,000 people from 58 countries.

Cohort studies report inconsistent associations between fish consumption, a major source of long-chain ꞷ-3 fatty acids, and risk of cardiovascular disease (CVD) and mortality. Whether the associations vary between those with and those without vascular disease is unknown.

This study aimed to examine whether the associations of fish consumption with risk of CVD or of mortality differ between individuals with and individuals without vascular disease.

This pooled analysis of individual participant data involved 191?558 individuals from 4 cohort studies—147 645 individuals (139 827 without CVD and 7818 with CVD) from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study and 43 413 patients with vascular disease in 3 prospective studies from 40 countries.

Fish consumption was recorded using validated food frequency questionnaires. In 1 of the cohorts with vascular disease, a separate qualitative food frequency questionnaire was used to assess intake of individual types of fish.

Mortality and major CVD events (including myocardial infarction, stroke, congestive heart failure, or sudden death).

-- Overall, 191 558 participants with a mean age of 54.1 years (91 666 male) were included in the present analysis.

-- During 9.1 years of follow-up in PURE, compared with little or no fish intake (less than 50 g/mo), an intake of 350 g/wk or more was not associated with risk of major CVD or total mortality.

-- By contrast, in the 3 cohorts of patients with vascular disease, the HR for risk of major CVD and total mortality was lowest with intakes of at least 175 g/wk (or approximately 2 servings/wk) compared with 50 g/mo or lower, with no further apparent decrease in HR with consumption of 350 g/wk or higher.

-- Fish with higher amounts of ꞷ-3 fatty acids were strongly associated with a lower risk of CVD, whereas other fish were neutral (collected in 1 cohort of patients with vascular disease).

-- The association between fish intake and each outcome varied by CVD status, with a lower risk found among patients with vascular disease but not in general populations.

Conclusively, findings of this pooled analysis of 4 cohort studies indicated that a minimal fish intake of 175 g (approximately 2 servings) weekly is associated with lower risk of major CVD and mortality among patients with prior CVD but not in general populations. The consumption of fish (especially oily fish) should be evaluated in randomized trials of clinical outcomes among people with vascular disease.