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(Circulation. 2001;103:623.)
© 2001 American Heart Association, Inc.

Editorials

Polyunsaturated Fatty Acids and Cardiovascular Events: A Fish Tale

J. Thomas Bigger, Jr, MD; Tarek El-Sherif, MD

From Columbia University, New York, NY.

Correspondence to J. Thomas Bigger, Jr, MD, Columbia University, 630 West 168th Street–PH 9-103D, New York, NY 10032.

Key Words: Editorials • arrythmia • lipids • prevention • death, sudden • nervous system, autonomic • ischemia

The Eskimo diet has a high fat content, but this group has a low incidence of deaths from coronary heart disease.¹ Because the Eskimo diet contains large amounts of long-chain polyunsaturated fatty acids (PUFAs),² many studies have been conducted to determine whether high dietary PUFAs may reduce death from coronary heart disease. These studies, which have focused on two n-3 PUFAs that are relatively abundant in fish, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), include many prospective epidemiological studies, a few case-control studies, and 2 secondary prevention trials.^{3 4 5 6 7 8 9 10 11 12 13} Most of the prospective population studies showed a statistically significant inverse relationship between fish consumption and the risk of death from coronary heart disease. The dose-response relationship was complex in these studies: the reduction in coronary risk was greatest when adding a modest amount of dietary fish to populations that previously had low fish intake. Increasing fish intake still more did not incrementally decrease risk. Many of these studies measured n-3 PUFA incorporation into the cell membranes of platelets, granulocytes, adipose tissue, or erythrocytes. Overall, there was a significant correlation between fish intake and the level of n-3 PUFA in cell membranes. The overall consistency in the observational studies is excellent and signals a survival benefit from dietary n-3 PUFA.

The epidemiological data suggest that the benefit of dietary fish is centered on a reduction in sudden cardiac death. A case-control study in Seattle compared 334 victims of out-of-hospital primary cardiac arrest with 493 population-based controls.¹¹ Compared with no dietary intake of . . . [Full Text of this Article]

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