Abstract
BackgroundWhether long-chain n–3 PUFAs of marine origin have an anti-atherogenic effect in the general population has hardly been studied. In this population-based study, we hypothesized that fatty fish and fish oil intake protect against development of novel atherosclerotic plaques and is associated with reduced plaque size.MethodsWe obtained questionnaire-based information on fish consumption and carotid ultrasonography from 3900 persons aged 45–74 years. The questionnaires were validated by measuring serum concentrations of PUFAs and triglycerides in a subgroup. At follow-up seven years later, 2983 (76%) went through a second ultrasound scanning. Logistic regression and general linear models were used to analyze the outcome (plaque presence and plaque area) as a function of fish consumption, including analyses stratified on fish oil supplements.ResultsAt baseline, lean fish intake < 1 time/week vs. 1–1.9 times/week was associated with risk of plaque (OR 1.34, 95% CI 1.03–1.76). Fatty fish intake and use of fish oil supplements were not statistically significantly associated with atherosclerosis at baseline. In persons without plaque at baseline, total fish consumption ≥3 times/week vs. 1–1.9 times/week was associated with risk of novel plaque (OR 1.32, 95% CI 1.01–1.73) and larger plaque area (1.76 mm2 vs. 1.46 mm2, p = 0.02) at follow-up. Adjustments for use of fish oil supplements had no impact on the associations, and no interactions were seen between total, fatty or lean fish consumption and fish oil intake.ConclusionsWe found no protective effect of fatty fish eating or fish oil supplements on atherosclerotic plaque formation or plaque area in a general population. Lean fish consumption was associated with a reduced risk for plaque in cross-sectional analysis, suggesting that the beneficial effects of fish consumption on atherosclerosis may be mediated through other mechanisms than n-3 PUFAs.
Highlights
Whether long-chain n–3 Polyunsaturated fatty acids (PUFA) of marine origin have an anti-atherogenic effect in the general population has hardly been studied
The use of fish oil supplements was associated with female sex, higher education, physical activity, not being a daily smoker, less boiled coffee drinking, as well as lower Body mass index (BMI), serum triglycerides, monocyte concentration, white cell count, fibrinogen and C-reactive protein (CRP) (Table 3)
We found an inverse trend between total fish consumption and serum triglycerides (Table 1) and that fish oil supplements were associated with low triglycerides (Table 3)
Summary
Whether long-chain n–3 PUFAs of marine origin have an anti-atherogenic effect in the general population has hardly been studied. In this population-based study, we hypothesized that fatty fish and fish oil intake protect against development of novel atherosclerotic plaques and is associated with reduced plaque size. Epidemiological, animal, and cell culture studies show that long-chain n–3 PUFAs of marine origin, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA), reduce the risk of cardiovascular diseases (CVD). Recent meta-analyses including newer randomized trials found that, except for a 10% reduction in sudden cardiac death among patients with prior MI, n-3 PUFA supplementation was not associated with a lower risk of all-cause mortality, non-fatal MI, or stroke [5, 6]. In the recent updated advisory report, the American Heart Association has endorsed the use of n-3 PUFA at a dose of approximately 1 g/day, either in the form of fatty fish or fish oil supplements in patients with a previous MI or in Johnsen et al Nutrition Journal (2018) 17:56 patients with heart failure without preserved left ventricular function [6]
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