Intake of fish and marine n-3 fatty acids in relation to coronary calcification: the Rotterdam Study

Background: Epidemiologic and experimental data suggest a cardioprotective effect of n–3 (omega-3) fatty acids from fish [eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA)]. Objective: The objective was to examine the association of fish and EPA plus DHA intakes with coronary calcification in a general older population. Design: Diet was assessed between 1990 and 1993 by using a semiquantitative 170-item food-frequency questionnaire. Coronary calcification was assessed 7 y later by electron-beam computed tomography in 1570 asymptomatic cardiac subjects with complete dietary data (44% men, mean age of 64 y). Calcium scores according to Agatston's method were divided into 10 (no/minimal coronary calcification), 11–400 (mild/moderate calcification), and >400 (severe calcification). Prevalence ratios (PRs) for mild/moderate and severe calcification were obtained in categories of fish and EPA plus DHA intake. PRs were adjusted for age, sex, body mass index, diabetes mellitus, socioeconomic status, smoking, alcohol intake, physical activity, and dietary factors. Results: Subjects with a fish intake >19 g/d had a significantly lower prevalence of mild/moderate calcification (PR: 0.87; 95% CI: 0.78, 0.98; full model) than did subjects who consumed no fish. Subjects with a high fish intake also had a lower prevalence of severe calcification (PR: 0.88; 95% CI: 0.74, 1.04), which was borderline statistically significant. EPA plus DHA intake showed no significant associations (PR: 0.93 and 0.97, respectively; P > 0.05). Conclusions: We found a weak inverse association between fish intake and coronary calcification. If confirmed in other population-based studies, more research is warranted to determine which components in fish can inhibit vascular calcification.