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n-3 fatty acids from fish and coronary artery disease: implications for public health

  • Erik B Schmidt (a1), Helle A Skou (a1), Jeppe H Christensen (a2) and Jørn Dyerberg (a3)



To review and discuss the effect of n-3 polyunsaturated fatty acids (PUFA) from fish in the prevention and, primarily, in the treatment of coronary artery disease (CAD).


Overview of the literature.




There is good evidence that fish consumption may reduce the risk of CAD.


Fish can be recommended to reduce the risk of CAD both in healthy subjects and in patients with a high risk of CAD or with documented CAD. The use of fish oil concentrates can not be recommended in general, but may be considered in patients after a myocardial infarction or in patients with hypertriglyceridaemia. An increased intake of n-3 polyunsaturated fatty acids from fish may have substantial implications for public health and health economy by decreasing the risk of coronary events and sudden cardiac death.

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1Schmidt, EB and Dyerberg, J.Omega-3 fatty acids: current status in cardiovascular medicine. Drugs 1994; 47: 405–24.
2Schmidt, EB. n-3 fatty acids and the risk of coronary heart disease. Dan. Med. Bull. 1997; 44: 122.
3Hepburn, FN, Exler, J and Weihrauch, JL. Provisional tables on the content of omega-3 fatty acids and other fat components of selected foods. J. Am. Diet. Assoc. 1986; 86: 788–93.
4Soriguer, F, Serns, SValverde, E, et al. Lipid, protein, and calorie content of different Atlantic and Mediterranean fish, shellfish, and molluscs commonly eaten in the south of Spain. Eur. J. Epidemiol. 1997; 13: 451–63.
5Rapp, JH, Connor, WE, Lin, DSPorter, JM. Dietary eicosapentaenoic acid and docosahexaenoic acid from fish oil. Their incorporation into advanced human atherosclerotic plaques. Arterioscler. Thromb. 1991; 11: 903–11.
6Fuster, V, Badimon, L, Badimon, JJChesebro, JH. The pathogenesis of coronary artery disease and the acute coronary syndromes. N. Engl. J. Med. 1992; 326: 310–18.
7Davies, MJ. Stability and instability: two faces of coronary atherosclerosis. Circulation 1996; 94: 2013–20.
8Mulvad, G, Pedersen, HS, Jul, E, et al. Atherosclerosis in Greenland natives. An autopsy study. Poster presented at the Ninth International Congress on Circumpolar Health, Reykjavik, Iceland, 20–25 June 1993.
9Newman, WP III, Propst, MT, Middaugh, JP. Atherosclerosis in Alaska natives and non-natives. Lancet 1993; 341: 1056–7.
10Hamazaki, T, Urakaze, M, Sawazaki, S, Yamazaki, K, Taki, H, Yano, S.Comparison of pulse wave velocity of the aorta between inhabitants of fishing and farming villages in Japan. Atherosclerosis 1988; 73: 157–60.
11Soei, LK, Lamers, JMJ, Sassen, LMA, et al. Fish oil: a modulator of experimental atherosclerosis in animals. In: Kristensen, SD, Schmidt, EB, De Caterina, R, Endres, S, eds. n-3 Fatty Acids: Prevention and Treatment of Vascular Disease. Springer Verlag: Bi & Gi Publishers, 1995; 5575.
12Hornstra, G. The significance of fish and and fish-oil enriched food for prevention and therapy of cardiovascular disease. In: Vergroesen, A, Crawford, M, eds. The Role of Fats in Human Nutrition. London: Academic Press, 1989; 152235.
13Lam, JYT, Badimon, JJ, Ellefson, RD, Fuster, V, Chesebro, JH. Cod liver oil alters platelet–arterial wall response to injury in pigs. Circ. Res. 1992; 71: 769–75.
14Harker, LA, Kelly, AB, Hanson, SR, et al. Interruption of vascular thrombus formation and vascular lesion formation by dietary n-3 fatty acids in fish oil in nonhuman primates. Circulation 1993; 87: 1017–29.
15Kim, D, Schmee, J and Baker, JE, et al. Dietary fish oil reduces microthrombi over atherosclerotic lesions in hyperlipidemic swine even in the absence of plasma cholesterol reduction. Exp. Mol. Pathol. 1993; 59: 122–35.
16National Cholesterol Education Program. Second report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (ATP II). Circulation 1994; 89, 1329–445.
17Wood, D, De Backer, G, Faergeman, O, Graham, I, Mancia, G, Pyorala, K.Prevention of coronary heart disease in clinical practice. Eur. Heart J. 1998; 19: 1434–503.
18Schmidt, EB, Kristensen, SD, De Caterina, R, Illingworth, DR. The effects of n-3 fatty acids on plasma lipids and lipoproteins and other cardiovascular risk factors in patients with hyperlipidemia. Atherosclerosis 1993; 103: 107–21.
19Harris, WS. n-3 fatty acids and lipoproteins: comparison of results from human and animal studies. Lipids 1996; 31: 243–52.
20Morris, MC, Sacks, F, Rosner, B.Does fish oil lower blood pressure? Circulation 1993; 88: 523–33.
21Toft, I, Bønaa, KH, Ingebretsen, OC, Nordøy, A and Jenssen, T.Effects of n-3 polyunsaturated fatty acids on glucose homeostasis and blood pressure in essential hypertention. Ann. Intern. Med. 1995; 123: 911–18.
22Ernst, E.Effects of n-3 fatty acids on blood rheology. J. Intern. Med. 1989; 225: (Suppl. 1), 129–32.
23Goode, GK, Garcia, S, Heagerty, AM. Dietary supplementation with marine fish oil improves. in vitro small artery endothelial function in hypercholesterolemic patients. Circulation 1997; 96: 2802–7.
24Rodriquez, BL, Sharp, DS, Abbott, RD, et al. . Fish intake may limit the increase in risk of coronary heart disease morbidity and mortality among heavy smokers. Circulation 1996; 94: 952–6.
25Shahar, E, Folsom, AR, Melnick, SL, et al. . Dietary n-3 polyunsaturated fatty acids and smoking-related chronic obstructive pulmonary disease. N. Engl. J. Med. 1994; 331: 228–33.
26Bjerregaard, P, Dyerberg, J.Mortality from ischaemic heart disease and cerebrovascular disease in Greenland. Int. J. Epidemiol. 1988; 17: 514–19.
27Kagawa, Y, Nishizawa, M and Suzuki, M, et al. Eicosapolyenoic acids of serum lipids of Japanese islanders with low incidence of cardiovascular diseases. J. Nutr. Sci. Vitaminol. 1982; 28: 441–53.
28Kromhout, D, Bosschieter, EB, Coulander, CDL. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N. Engl. J. Med. 1985; 312: 1205–9.
29Kromhout, D, Feskens, EJM, Bowles, CH. The protective effect of a small amount of fish on coronary heart disease mortality in an elderly population. Int. J. Epidemiol. 1995; 24: 340–5.
30Daviglus, ML, Stamler, J, Orencia, AJ, et al. Fish consumption and the 30-year risk of fatal myocardial infarction. N. Engl. J. Med. 1997; 336: 1046–53.
31Norell, SE, Ahlbom, A, Feychting, M, et al. Fish consumption and mortality from heart disease. BMJ 1986; 293, 426.
32Gramenzi, A, Gentile, A, Fasoli, M, et al. Association between certain foods and risk of acute myocardial infarction in women. BMJ 1990; 300: 771–3.
33Dolecek, TA, Grandits, G.Dietary polyunsaturated fatty acids and mortality in the multiple risk factor intervention trial (MRFIT). World Rev. Nutr. Diet. 1991; 66: 205–16.
34Feskens, EJM, Bowles, CH, Kromhout, D.Association between fish intake and coronary heart disease mortality. Diabetes Care 1993; 16: 1029–34.
35Morris, MC, Manson, JAE, Rosner, B, Buring, JE, Willett, WC, Hennekens, CH. Fish consumption and cardiovascular disease in the Physician's Health Study: a prospective study. Am. J. Epidemiol. 1995; 142: 166–75.
36Crombie, IK, McLoone, P and Smith, WCS, et al. International differences in coronary heart disease mortality and consumption of fish and other foodstuffs. Eur. Heart J. 1987; 8: 560–3.
37Vollset, SE, Heuch, I, Bjelke, E.Fish consumption and coronary heart disease. N. Engl. J. Med. 1985; 313: 820–1.
38Lapidus, L, Andersson, H, Bengtsson, C, et al. Dietary habits in relation to incidence of cardiovascular disease and death in women: a 12-year follow-up of participants in the population study of women in Gothenburg, Sweden. Am. J. Clin. Nutr. 1986; 44: 444–8.
39Simonsen, T, Vårtun, Å and Lyngmo, V, et al. Coronary heart disease, serum lipids, platelets and dietary fish in two communities in northern Norway. Acta Med. Scand. 1987; 222: 237–45.
40Ascherio, A, Rimm, EB, Stampfer, MJ, Giovannucci, EL and Willett, WC. Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men. N. Engl. J. Med. 1995; 332: 977–82.
41Albert, CM, Hennekens, CH, O'Donnell, CJ, et al. Fish consumption and risk of sudden cardiac death. JAMA 1998; 279: 23–8.
42Saynor, R, Verel, D, Gillott, T.The long term effect of dietary supplementation with fish lipid concentrate on serum lipids, bleeding time, platelets and angina. Atherosclerosis 1984; 50: 310.
43Kristensen, SD, Schmidt, EB, Andersen, HR, Dyerberg, J.Fish oil in angina pectoris. Atherosclerosis 1987; 64: 1319.
44Burr, ML, Fehily, AM, Gilbert, JF. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet 1989; 2, 757–61.
45De Lorgeril, M, Renaud, S, Mamelle, N, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994; 343: 1454–9.
46Singh, RB, Niaz, MA, Sharma, JP, Kumar, R, Rastogi, V, Moshiri, M.Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival – 4. Cardiovasc. Drugs Ther. 1997; 11: 485–91.
47Gapinski, JP, VanRuiswyk, JV, Heudebert, GR, Schectman, GS. Preventing restenosis with fish oils following coronary angioplasty. A meta-analysis. Arch. Intern. Med. 1993; 153: 1595–601.
48Cairns, JA, Gill, J and Morton, B, et al. Fish oils and low-molecular-weight heparin for the reduction of restenosis after percutaneous transluminal coronary angioplasty. Circulation 1994; 94, 1553–60.
49Leaf, A, Jorgensen, MB, Jacobs, AK, et al. Do fish oils prevent restenosis after coronary angioplasty? Circulation 1994; 90: 2248–57.
50Johansen, O, Brekke, M, Seljeflot, I, Abdelnoor, M, Arnesen, H.n-3 fatty acids do not prevent restenosis after coronary angioplasty: results from the CART study. J. Am. Coll. Cardiol. 1999; 33: 1619–26.
51Roy, L, Meyer, F, Gingras, L and Auger, L.A double-blind randomized controlled study comparing the efficacy of fish oil and low dose ASA to prevent coronary saphenous vein graft obstruction after CABG. Circulation 1991; 84(Suppl. II), II285.
52Eritsland, J, Arnesen, H, Grønseth, K, Fjeld, NB, Abdelnoor, M.Effect of dietary supplementation with n-3 fatty acids on coronary artery bypass graft patency. Am. J. Cardiol. 1996; 77: 31–6.
53Charnock, JS, McLennan, PL and Abeywardena, MY. Dietary modulation of lipid metabolism and mechanical performance of the heart. Mol. Cell. Biochem. 1992; 116: 1925.
54McLennan, PL. Relative effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on cardiac arrhythmias in rats. Am. J. Clin. Nutr. 1993; 57: 207–12.
55Nair, SSD, Leitch, JW, Falconer, J, Garg, ML. Prevention of cardiac arrhythmia by dietary (n-3) polyunsaturated fatty acids and their mechanism of action. J. Nutr. 1997; 127: 383–93.
56Hallaq, H, Smith, TW, Leaf, A.Modulation of dihydropyridine-sensitive calcium channels in heart cells by fish oil fatty acids. Proc. Natl. Acad. Sci. USA 1992; 89: 1760–4.
57Kang, JX, Leaf, A.Prevention and termination of beta-adrenergic agonist-induced arrhythmias by free polyunsaturated fatty acids in neonatal rat cardiac myocytes. Biochem. Biophys. Res. Commun. 1995; 208: 629–36.
58Garratt, JC, McEnvoy, MP, Owen, DG. Blockade of two voltage-dependent potassium channels, mKv 1.1 and mKv 1.2, by docosahexaenoic acid. Eur. J. Pharmacol. 1996; 14, 393–6.
59Kang, JX, Leaf, A.Antiarrhythmic effects of polyunsaturated fatty acids. Recent studies. Circulation 1996; 94: 1774–80.
60Luostarinen, R, Boberg, M, Saldeen, T.Fatty acid composition in total phospholipids of human coronary arteries in sudden cardiac death. Atherosclerosis 1993; 99: 187–93.
61Siscovick, DS, Raghunathan, TE, King, I, et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995; 274: 1363–7.
62Christensen, JH, Gustenhoff, P, Ejlersen, E, et al. n-3 fatty acids and ventricular extrasystoles in patients with ventricular tachyarrhythmias. Nutr. Res. 1995; 15, 18.
63Sellmayer, A, Witzgall, H, Lorenz, RL, Weber, PC. Effects of dietary fish oil on ventricular premature complexes. Am. J. Cardiol. 1995; 76: 974–7.
64Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Circulation 1996; 93, 1043–65.
65Christensen, JH, Gustenhoff, P and Korup, E, et al. Effect of fish oil on heart rate variability in survivors of myocardial infarction: a double blind randomised controlled trial. BMJ 1996; 312: 677–8.
66Christensen, JH, Korup, E and Aarøe, J, et al. Fish consumption, n-3 fatty acids in cell membranes, and heart rate variability in survivors of myocardial infarction with left ventricular dysfunction. Am. J. Cardiol. 1997; 79: 1670–3.
67Christensen, JH, Aarøe, J, Knudsen, N, et al. Heart rate variability and n-3 fatty acids in patients with chronic renal failure – a pilot study. Clin. Nephrol. 1998; 49: 102–6.
68Christensen, JH, Christensen, MS, Dyerberg, J, Schmidt, EB. Fatty acids in blood cell membranes is related to heart rate variability. A dose–response study with n-3 fatty acids. Am. J. Clin. Nutr. 1999; 70: 331–7.
69Seidelin, KN, Myrup, B, Fischer-Hansen, B.n-3 fatty acids in adipose tissue and coronary artery disease are inversely related. Am. J. Clin. Nutr. 1992; 55: 1117–19.
70Sacks, FM, Stone, PH, Gibson, M, Silverman, DI, Rosner, B, Pasternak, RC. Controlled trial of fish oil for regression of human coronary atherosclerosis. J. Am. Coll. Cardiol. 1995; 25: 1492–8.
71Von Schacky, C, Angerer, P, Kothny, W, Theisen, K, Mudra, H.The effect of dietary omega-3 fatty acids on coronary atherosclerosis. A randomized, double-blind, placebo-controlled trial. Ann. Intern. Med. 1999; 130: 554–62.
72Salonen, JT, Seppänen, K, Nyyssönen, K, et al. Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction and coronary, cardiovascular, and any death in eastern Finnish men. Circulation 1995; 91: 645–55.
73Witzkum, JL and Steinberg, D.Role of oxidized low density lipoprotein in atherogenesis. J. Clin. Invest. 1991; 88: 1785–92.
74Suzukawa, M, Abbey, M, Howe, PR, Nestel, PJ. Effect of fish oil fatty acids on low density lipoprotein size, oxidizability, and uptake by macrophages. J. Lipid Res. 1995; 36: 473–84.
75Brude, IR, Drevon, CA, Hjermann, I, et al. Peroxidation of LDL from combined-hyperlipidemic male smokers supplied with ω-3 fatty acids and antioxidants. Arterioscler. Thromb. Vasc. Biol. 1997; 17: 2576–88.
76Smith, P, Arnesen, H, Opstad, T, et al. Influence of highly concentrated n-3 fatty acids on serum lipids and hemostatic variables in survivors of myocardial infarction receiving either oral anticoagulants or matching placebo. Thromb. Res. 1989; 53: 467–74.
77Bender, NK, Kraynak, MA, Chiquette, E, Linn, WD, Clark, GM and Bussey, HI. Effects of marine fish oils on the anticoagulation status of patients receiving chronic warfarin therapy. J. Thromb. Thrombolys. 1998; 5, 257–61.
78Schmidt, EB, Møller, JM, Svaneborg, N and Dyerberg, J.Safety aspects of fish oils. Drug Invest. 1994; 7, 215–20.
79Sirtori, CR, Paoletti, R, Mancini, M, et al. n-3 fatty acids do not lead to an increased diabetic risk in patients with hyperlipidemia and abnormal glucose tolerance. Am. J. Clin. Nutr. 1997; 65: 1874–81.
80 Friedberg, Janssen, MJFM, Heine, RJ, Grobbee, DE. Fish oil and glycemic control in diabetes. A meta-analysis. Diabetes Care 1998; 21, 494500.
81Weber, PC. Clinical studies on the effect of n-3 fatty acids on cells and eicosanoids in the cardiovascular system. J. Intern. Med. 1989; 225(Suppl. 1), 61–8.
82Skuladottir, GV, Gudmundsdottir, S, Olafsson, GB, et al. Plasma fatty acids and lipids in two separate, but genetically comparable, Icelandic populations. Lipids 1995; 30: 649–55.
83Newton, IS. Global food fortification perspectives of long-chained omega 3 fatty acids. In: Simopoulos, AP, ed. The Return of Omega 3 Fatty Acids into the Food Supply. I. Land-based Animal Food Products and their Health Effects. Basel: Karger, 1998; 199209.
84Health and Welfare Canada. Nutrition Recommendations. Ottawa: Minister of Supply and Services, 1990.
85 British Nutritional Foundation. Unsaturated Fatty Acids: Nutritional and Physiological Significance. Report of the British Nutritional Foundation's Task Force. BNF, 1992.
86Norris, RM. Fatality outside hospital from acute coronary events in three British health districts, 1994–5. BMJ 1998; 316: 1065–70.
87Barron, HV, Viskin, S.Autonomic markers and prediction of cardiac death after myocardial infarction. Lancet 1998; 351: 461–2.
88De Deckere, EAM, Korver, O, Verscheuren, PM, Katan, MB. Health aspects of fish and n-3 polyunsaturated fatty acids from plant and marine origin. Eur. J. Clin. Invest. 1998; 52: 749–53.


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n-3 fatty acids from fish and coronary artery disease: implications for public health

  • Erik B Schmidt (a1), Helle A Skou (a1), Jeppe H Christensen (a2) and Jørn Dyerberg (a3)


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