Fish Oil in Health and Disease

BOSTON, MASSACHUSETTS. There is a growing consensus that regular fish consumption protects against heart disease. There is, however, still controversy as to whether this protection applies to all forms of heart disease and it is also not clear how fish exerts its protective effect. Some studies have found that fish consumption protects only against sudden cardiac death while others have found that it protects only against nonsudden death. Now researchers at the Harvard Medical School and the Brigham and Women's Hospital weigh in with a comprehensive new study which concludes that even modest fish and shellfish consumption protects against sudden cardiac death in men and significantly reduces total mortality. The study involved over 20,000 male American physicians who were between the ages of 40 and 84 years in 1982 when the study commenced. Food frequency questionnaires were administered after 12 and 18 months and again in 1988. By December 1995 133 of the participants had died from a sudden cardiac event (death occurring within one hour from onset of symptoms). Analysis of the collected data showed that the men who consumed fish once or more each week had a 52 per cent lower risk of dying from a sudden cardiac event than did the men who ate fish less than once a month. This lower risk applied after adjusting for all other known risk factors. The estimated dietary intake of marine n-3 fatty acids also correlated well with the risk of sudden cardiac death with an intake of more than 300 mg/month providing significant protection. The extent of protection did not increase significantly with greater fish or marine n-3 fatty acid intake indicating that eating fish once a week is sufficient to provide worthwhile protection.

Fish consumption was not associated with the risk of nonsudden death, total myocardial infarction or total deaths from cardiovascular diseases. There was, however, a 30 per cent decrease in the overall mortality among the men consuming fish once or more each week as compared to the men eating fish less than once per month. The researchers speculate that fish consumption may exert its protective effect by preventing fatal arrhythmias. They suggest that the n-3 fatty acids found in fish and shellfish (eicosapentaenoic acid and docosahexaenoic acid) are responsible for the antiarrhythmic properties and point out that alpha-linolenic acid, an n-3 fatty acid found in flax oil and nuts, also has antiarrhythmic properties. They did not investigate the benefits of fish oil supplements and purposely excluded 777 physicians from the study who were taking fish oil supplements. The researchers conclude that eating fish once per week may substantially reduce the risk of sudden cardiac death. In an accompanying editorial Dr. Daan Kromhout of the Dutch National Institute of Public Health concurs with this conclusion and adds that patients already suffering from cardiac disease should be advised to eat fish twice a week.
Albert, Christine M., et al. Fish consumption and risk of sudden cardiac death. Journal of the American Medical Association, Vol. 279, January 7, 1998, pp. 23-28
Kromhout, Daan. Fish consumption and sudden cardiac death. Journal of the American Medical Association, Vol. 279, January 7, 1998, pp. 65-66 (editorial)

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