Elsevier

Progress in Cardiovascular Diseases

Volume 52, Issue 2, September–October 2009, Pages 95-114
Progress in Cardiovascular Diseases

Fish, Long-Chain Omega-3 Polyunsaturated Fatty Acids and Prevention of Cardiovascular Disease—Eat Fish or Take Fish Oil Supplement?

https://doi.org/10.1016/j.pcad.2009.06.003Get rights and content

Abstract

The association between fish consumption and risk of cardiovascular disease (CVD) has been extensively studied. Although the results are inconsistent, the majority of studies are in favor of cardioprotective effects of fish consumption. There is little doubt that long-chain ω-3 polyunsaturated fatty acids (LCn-3PUFAs) in fish are the key nutrients responsible for the benefits and are important for CVD prevention. Although fish is valued as a source of these fatty acids, it also provides other nutrients that may have cardioprotective effects. It is likely that the beneficial effects of fish consumption on the risk of CVD are the synergistic effects among nutrients in fish, and the integrative effects of fish consumption may reflect the interactions of nutrients and contaminants in fish. This review summarizes the epidemiology of fish or LCn-3PUFAs with major CVD risk factors as well as coronary heart disease mortality and stroke. This review also discusses the possible difference between whole fish as a nutrient package and fish oil supplements as a source of LCn-3PUFAs with respect to CVD prevention. Further studies are needed to investigate the potential adverse effects of contaminants in fish and the possible different effects from different types of fish and cooking methods.

Section snippets

The ω-3 and ω-6 fatty acids

The effects of individual fatty acids on biochemical and physiological functions are determined by a combination of chain length, the number and placement of double bonds, and isomerism around these bonds. ω-3 and ω-6 fatty acids, depending on the location of the first double bond, are 2 major groups of polyunsaturated fatty acids. Linoleic acid (LA, 18:2 ω-6) and α-linolenic acid (ALA, 18:3 ω-3) are 2 essential fatty acids to humans because only algae and some fungi are able to form these

LCn3PUFAs, fish, and CVD risk factors

A large body of evidence supports that fish consumption or LCn3PUFA intake may provide cardioprotective effects.17, 18, 19 A beneficial effect of fish consumption or LCn3PUFA intake on CVD has been suggested to be related to the overall favorable effects on lipid profiles,20, 21, 22, 23 threshold for arrhythmias,24, 25 platelet activity,26, 27, 28 inflammation and endothelial function,29, 30, 31 atherosclerosis,32, 33 and hypertension.34

Fish and coronary heart disease

The hypothesis that fish consumption may reduce risk of CHD has been examined in various populations. A few case-control studies have been published,95, 96, 97, 98 and three95, 96, 97 of 4 reported a significant inverse association between fish consumption and CHD (Table 1A). The results from prospective cohort studies have been inconsistent: some studies showed a significant inverse association between fish and CHD,99, 100, 101, 102, 103, 104, 105, 106 whereas others found no significant

Fish and stroke

Strokes are generally classified into 2 groups: ischemic stroke and hemorrhagic stroke. The etiologies of these 2 types of stroke are entirely different. Because of the potential antiplatelet aggregation property of LCn3PUFAs, it was hypothesized that fish consumption may be inversely associated with ischemic stroke but not with hemorrhagic stroke.2, 4 The observation of high incidence of hemorrhage in Eskimos, who consume large amounts of fish, has raised concerns about possible adverse

Eating fish or taking fish oil supplements?

The beneficial effects of fish consumption on CVD, particularly fatal CHD, have been increasingly recognized.17, 19 Long-chain ω-3 polyunsaturated fatty acids including EPA and DHA have been suggested to be the key nutrients in fish responsible for its favorable effects. Although the findings from previous studies are inconsistent, the accumulated evidence to date is generally in favor of the beneficial effects of fish consumption in reducing risk of CVD. However, several issues merit being

Summary

Numerous experimental and observational studies have examined fish consumption and LCn3PUFA intake in relation to CVD risk. The inconsistent results may be explained by the study variations in sample size, follow-up period, dose of LCn3PUFAs used, dietary assessment method, and measurement of the health end points, etc. Nevertheless, the cumulative evidence is generally in favor of the beneficial effects of fish consumption in reducing risk of CVD, particularly fatal CHD. Although the

Statement of Conflict of Interest

All authors declare that there are no conflicts of interest.

Acknowledgments

The author thanks Dr. Pengcheng Xun for his help with the preparation for the manuscript.

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    Statement of Conflict of Interest: see page 110.

    This work was supported in part by the UNC-CH IBM junior faculty award.

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