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Take Fish to Heart

Several studies just published in the highly respected Journal of the American Medical Association (JAMA) and the New England Journal of Medicine, add to a large and growing body of research that shows fish are among the healthiest of the World’s Healthiest Foods. Within the last week, the two studies, building on two earlier Italian studies published in Circulation and Lipids have provided additional reasons to take fish to heart.

The JAMA study was a prospective study of apparently healthy men who were followed for up to 17 years in the Physicians' Health Study. The previously collected blood samples of 94 men who died suddenly with no history of cardiovascular disease were analyzed for fatty-acid composition, and the results were compared with 184 controls matched for age and smoking status.

Researchers found that base-line blood levels of omega-3 fatty acids were significantly inversely related to the risk of sudden death. Compared to men with the lowest blood levels of omega-3s, those with the highest blood levels of omega-3s had an 81% lower risk of sudden death from a heart attack. Researchers in the Division of Preventive Medicine at Brigham and Women's Hospital, Boston, MA, who conducted this study, concluded that frequent consumption of the omega-3 fats found in fish is strongly associated with a reduced risk of sudden death among men without evidence of prior cardiovascular disease.

Not only is fish a heart-healthy food for real healthy men, it also protects against cardiovascular disease and cardiovascular-related death in women, as the study published this week in the New England Journal of Medicine clearly shows. This study evaluated data collected on 84,688 female nurses enrolled in the Nurses' Health Study, who were aged 34 to 59 years and were free from cardiovascular disease and cancer when the study began in 1980. During 16 years of follow-up, 484 of these women died due to cardiovascular disease and an additional 1,029 suffered nonfatal heart attacks.

Compared with women who ate fish less than once per month, those who consumed fish more frequently had a much lower risk of cardiovascular disease. And the more frequently a woman ate fish, the lower her risk for cardiovascular disease became, an association that still held after adjustment for age, smoking, and other cardiovascular risk factors. Women who ate fish just 1-3 times per month had a 21% lower risk of cardiovascular disease. Those who consumed fish once each week had a 29% lower risk; those who consumed fish 2-4 times each week had a 31% lower risk, and those who ate fish 5 or more times per week had a 34% lower risk. The biggest winners, those women with the lowest risk for a fatal or non-fatal heart attack were those who not only ate fish the most frequently, but also ate those fish highest in omega-3 fatty acids. Among this group, risk for a nonfatal heart attack was 27% lower, while risk for a fatal heart attack was 45% lower.

Lastly, two GISSI-Prevenzione studies, Italian studies published in Circulation, the journal of the American Heart Association, and another highly respected journal, Lipids, found that a daily gram of omega-3 fatty acids reduced overall risk of death and the risk of sudden death from a heart attack in people who had already had a heart attack. The first trial, which tested long term supplementation with omega-3 fats (1 gram per day) or vitamin E (300 IU per day), found that omega-3s, but not vitamin E, significantly reduced risk of both nonfatal and fatal heart attack and stroke. According to the researchers, up to 5.7 lives could be saved for every 1000 patients with a previous heart attack who were treated with omega-3 fatty acids (1 g daily) per year. Researchers further added that such a result is comparable to that observed in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) trial, where 5.2 lives could be saved per 1000 hypercholesterolemic, coronary heart disease patients treated with pravastatin for 1 yr.”

The second Italian GISSI Prevenzione study was a placebo-controlled randomized trial that included more than 11,300 participants who were divided into four groups of comparable size. One group received 1 gram each day of omega-3s. A second group was given 300 milligrams of vitamin E each day. A third group took both omega-3s and vitamin E, and the fourth group took a placebo.

Although all study participants already consumed a protective diet rich in fruits, vegetables, olive oil and fish, among those who received the fish oil supplements, fewer sudden deaths occurred than among those who didn’t. Researchers think that omega-3 fatty acids protect against death from coronary heart disease by helping to reduce episodes of arrhythmia, or irregular heartbeats, which are a major precipitating factor in heart attacks.

The American Heart Association, however, does not endorse taking fish oil supplements as the best way to protect your heart; they endorse a healthy diet that includes omega-3-rich fish. Dr. Alice H. Lichtenstein, Vice President of the American Heart Association's Nutrition Committee, says, “I personally am not willing to say at this point that supplements are a good substitute for fish.” Cardiologist Dr. Ramin Farshi of Los Angeles, California concurs and notes, “As a cardiologist, I generally recommend having fish at least one to two times a week.”

For suggestions as to how follow this advice to enjoy fish-rich in omega-3 fats, such as salmon, cod and albacore tuna, more frequently, click on the Recipe Assistant, select the fish desired from the healthy foods list, and click on the Submit button. A list containing links to all the World's Healthiest Foods' recipes containing the fish chosen will appear immediately below.


Albert CM, Campos H, Stampfer MJ, Ridker PM, Manson JE, Willett WC, Ma J. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002 Apr 11;346(15):1113-8

Hu FB, Bronner L, Willett WC, Stampfer MJ, Rexrode KM, Albert CM, Hunter D, Manson JE. Fish and omega-3 Fatty Acid intake and risk of coronary heart disease in women. JAMA 2002 Apr 10;287(14):1815-21.

Tavani A, Pelucchi C, Negri E, Bertuzzi M, La Vecchia C. n-3 Polyunsaturated fatty acids, fish, and nonfatal acute myocardial infarction. Circulation 2001 Nov 6;104(19):2269-72.

Marchioli R, Schweiger C, Tavazzi L, Valagussa F. Efficacy of n-3 polyunsaturated fatty acids after myocardial infarction: results of GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico. Lipids 2001;36 Suppl:S119-26

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