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European Heart Journal Advance Access originally published online on July 18, 2008
European Heart Journal 2008 29(16):2024-2030; doi:10.1093/eurheartj/ehn294
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Long-term fish consumption and n-3 fatty acid intake in relation to (sudden) coronary heart disease death: the Zutphen study

Martinette T. Streppel1,2,*, Marga C. Ocké1, Hendriek C. Boshuizen1, Frans J. Kok2 and Daan Kromhout2

1 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
2 Division of Human Nutrition, Wageningen University, PO Box 8129, 6700 EV Wageningen, The Netherlands

Received 7 November 2007; revised 9 June 2008; accepted 11 June 2008; online publish-ahead-of-print 18 July 2008.

*Corresponding author. Tel: +31 317 482880, Fax: +31 317 482782, Email: martinette.streppel{at}wur.nl

Aims: To assess the relationship between fish consumption or eicosapentaenoic acid (EPA)+docosahexaenoic acid (DHA) intake from fish, and (sudden) coronary death.

Methods and results: The impact of recent and long-term fish consumption and EPA+DHA intake on (sudden) coronary death was investigated in the Zutphen Study, a cohort of 1373 men born between 1900 and 1920, and examined repeatedly between 1960 and 2000. Hazard ratios were obtained from time-dependent Cox regression models. The associations between long-term fish consumption, EPA+DHA intake, and (sudden) coronary death were stronger than those of recent consumption. Long-term fish consumption was inversely associated (borderline significant) with coronary heart disease (CHD) death; however, the strength of the association decreased from age 50 [HR: 0.32 (95% CI: 0.13–0.80)] until age 80 [HR: 1.34 (0.58–3.12)]. For men with a daily EPA+DHA intake from fish below 250 mg compared with no intake, CHD death risk was reduced to the same extent as for men with a daily intake above 250 mg (P-value for trend: 0.27). Moreover, long-term fatty-fish consumption lowered the risk of sudden coronary death [HR: 0.46 (0.27–0.78)].

Conclusion: The strength of the association between long-term fish consumption and CHD death decreased with increasing age. Fatty-fish consumption lowered sudden coronary death risk. There was no clear dose–response relationship between EPA+DHA intake and (sudden) coronary death.

Key Words: Fish • Eicosapentaenoic acid • Docosahexaenoic acid • Coronary heart disease • Sudden coronary death


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