N-3 Polyunsaturated Fatty Acids from Fish and Cardiovascular Disease

The n-3 polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from fish are associated with a reduced risk of fatal coronary heart disease (CHD) and cardiovascular disease (CVD).We examined whether these associations also existed in a general Dutch population with a relatively low fish intake. Design: For the present analysis we used data from a population-based cohort of a Dutch monitoring study. Between 1993 and 1997, participants filled out a lifestyle and health and a food frequency questionnaire. Anthropometrics and blood pressure were measured and blood samples were taken. The present analyses comprised 9,118 men and 11,030 women aged 20-59 years with no history of myocardial infarction or stroke. Data were analysed with the Cox proportional hazard model, with adjustments for age, gender, body mass index, supplement use, use of cholesterol lowering or anti-hypertensive drugs, family history of CVD, education level, smoking, alcohol intake, and daily intake of energy, fruit, vegetables, and saturated fat. CHD and CVD were classified according to the International Classification of Diseases, 9th and 10th revision (ICD-10, WHO). Results: Median intakes in quartiles of EPA+DHA were 39, 84, 150, and 233 mg/day. During 8-13 years of follow-up, 607 patients died of which 155 of CVD and 82 of CHD. The adjusted hazard ratio (HR) for fatal CHD was significantly lower in the highest quartile of EPA+DHA (0.53; 95%CI: 0.28-0.99) as compared to the lowest quartile. For fatal CVD, we did not find this association (Q4: 0.85; 95%CI: 0.54-1.33). The number of incident cases (fatal cases+hospital admissions) was 1,157 for CVD and 752 for CHD. The HRs for incident CVD across quartiles of EPA+DHA intake compared to the lowest quartile were as follows: 1.01 (0.85-1.20), 1.07 (0.90-1.27), 0.97 (0.82-1.15). For incident CHD these HRs were: 0.90 (0.72-1.11), 1.06 (0.86-1.30), and 0.97 (0.79-1.19). Conclusion: Dietary EPA+DHA is associated with fatal CHD, even in a population with a low fish intake. We found no associations of EPA+DHA with non-fatal CHD and with fatal and non-fatal CVD