Issue 150 Item 14 Increased Fish Consumption Lowers Heart Disease Risk for Diabe

Risk of coronary heart disease declined from 70% for women who consumed fish 1 to 3 times per month to 38%. Regular consumption of fish may significantly reduce the risk of heart disease in women with diabetes.

Several studies have shown an inverse association between fish consumption and coronary heart disease or sudden cardiac death risk in the general population, the authors explain, but limited information is available about such a link among diabetic patients.

Dr. Frank Hu and colleagues from Harvard Medical School in Boston, Massachusetts used data from 5103 female nurses with type 2 diabetes in the Nurses’ Health Study cohort to examine the association between the intake of fish and omega-3 fatty acids and the risk of coronary heart disease and overall mortality.

More frequent fish consumption was associated with a diminishing risk of coronary heart disease, the authors report. After adjustment for other cardiovascular risk factors, the relative risk of coronary heart disease declined from 70% for women who consumed fish 1 to 3 times per month to 38% for women who ate fish at least 5 times a week.

The age-adjusted relative risk of total mortality also fell with increasing fish intake, the report indicates, to 54% among women consuming fish at least 5 times a week. Increased intake of omega-3 fatty acids was also associated with a significantly lower risk of coronary heart disease, the researchers note, especially among those who were not regular users of aspirin. Total mortality risk also fell with greater omega-3 fatty acid intake.

This study supports the American Heart Association recommendation of at least 2 servings of fish per week for both diabetics and nondiabetics.

“Currently there are no definitive data on fish oil among diabetics. But based on existing data,” Dr. Hu explained, “fish oil supplement should be beneficial for diabetics, especially for those with high triglycerides. Fish oil can substantially lower triglycerides.”

“Expert opinion in the dietary field now favors moderate increases in intakes of plant-derived alpha-linolenic acid based on epidemiological evidence of benefit for cardiovascular disease risk reduction,” writes Dr. Scott Grundy from University of Texas Southwestern Medical Center at Dallas, Texas in a related editorial. “The same is true for ‘increased fish intake,’ which likewise is based on epidemiological evidence.”

“American Heart Association’s recent guideline for using fish-oil supplements for patients with established coronary heart disease is more problematic,” Dr. Grundy said. “Available evidence is suggestive of benefit in the immediate post-MI period, but a solid recommendation cannot be made without more definitive controlled clinical trials.” Circulation 1 April 2003