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The relationship between fish consumption and the risk of cardiovascular disease and death in individuals with and without vascular disease

Cohort studies provide conflicting information on the effects of consumption of fish, a major source of long-chain ω-3 fatty acids, on the risk of cardiovascular disease (CVD) and death. Whether the associations vary between those with and those without vascular disease is unknown.

The study included 191,558 patients from 4 cohort studies: 147,645 people from the PURE study (139,827 without CVD and 7818 with CVD) from 21 countries; and 43,413 patients with vascular disease in 3 prospective studies from 40 countries.

Estimated indicators: mortality and major cardiovascular events (myocardial infarction, stroke, heart failure, sudden death).±8.0 years) were included in the study, of which 91,666 [47.9%] were men. During the 9.1 year follow-up in the PURE study, compared with little or no fish intake (≤50 g / month), intake of 350 g / week or more was not associated with the risk of serious cardiovascular disease (HR, 0.95 ; 95% CI). 0.86–1.04) or overall mortality (RR 0.96; 0.88–1.05). By contrast, in the 3 cohorts of patients with vascular disease, the HR for risk of major CVD (HR, 0.84; 95% CI, 0.73-0.96) and total mortality (HR, 0.82; 95% CI, 0.74-0.91) 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. Consumption of fish with higher ω-3 fatty acids was strongly associated with a lower risk of cardiovascular disease (HR, 0.94; 95% CI, 0.92-0.97), whereas other fish were neutral (collected in 1 cohort of patients with vascular disease).

Findings from this pooled analysis of 4 cohort studies showed that a minimum fish intake of 175 g (approximately 2 servings) per week is associated with a lower risk of serious cardiovascular disease and mortality in patients with preexisting cardiovascular disease, but not in the general population.

JAMA Intern Med. Published online March 8, 2021. doi:10.1001/jamainternmed.2021.0036

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