Fish intake and risk of incident atrial fibrillation

D Mozaffarian,B.M Psaty,E.B Romm

doi:10.1016/j.accreview.2004.10.011

Abstract

Study Question: Does fish intake influence the incident rate of atrial fibrillation? Methods: The Cardiovascular Health Study, a population-based prospective cohort study, was used to prospectively identify subjects with new-onset atrial fibrillation (AF) on the basis of hospital discharge records and annual electrocardiograms. The fish consumption and usual dietary intake was assessed at baseline in 4815 adults ≥age 65 years in 1989 and 1990, with a mean follow-up of 12 years. Results: Mean age was 72 years, 95% were white, about 20% had diabetes and 20% had coronary disease; mean sBP was 135 mm Hg and 45% were treated for hypertension. Incident AF was detected in 980 subjects. In multivariate analyses, consumption of tuna or other broiled or baked fish was inversely associated with incidence of AF, with a 28% lower risk with intake 1 to 4 times per week (HR=0.72; 95% CI=0.58–0.91; p=0.005), and 31% lower risk with intake ≥5 times per week (HR=0.69; 95% CI=0.52–0.91; p=0.008), compared with <1 time per month (p trend=0.004). Results were not materially different after adjustment for preceding myocardial infarction (MI) or congestive heart failure. In similar analyses, fried fish/fish sandwich consumption was not associated with lower risk of AF. Conclusions: Among elderly adults, consumption of tuna or other broiled or baked fish, but not fried fish or fish sandwiches, is associated with lower incidence of AF. Fish intake may influence risk of this common cardiac arrhythmia. Perspective: The study results are consistent with the clinical studies demonstrating less sudden death in coronary disease and the putative anti-arrhythmic effects of n-3 fatty acids including decreased ventricular myocyte excitability, and termination of induced asynchronous contraction in atrial myocytes. Fish oil intake can result in replacement of cardiac cellular membrane arachidonic acid by eicosapentaenoic acid. Why not fried fish? It is not the beer because alcohol intake was not greater in the fried fish/fish sandwich group. Frying can change the n-3 to n-6 PUFAs and lead to formation of trans-fatty acids. MR

Highlights

Background——Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is common in the elderly
Tuna/other fish consumption was associated with younger age, female gender, and higher education, whereas fried fish/fish sandwich consumption was associated with male gender, nonwhite race, and lower education (Table 1)
The association persisted after adjustment for a variety of demographic, clinical, lifestyle, laboratory, and dietary characteristics, including preceding myocardial infarction (MI) and congestive heart failure (CHF)

Summary

Introduction

Background——Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is common in the elderly. Fish consumption appears to reduce risk of fatal ventricular arrhythmias, consistent with antiarrhythmic effects of longchain n-3 polyunsaturated fatty acids in fish.[17,18,19,20,21,22,23,24] In cultured rat atrial myocytes, n-3 fatty acids reduce induced asynchronous contractile activity,[25] suggesting that n-3 fatty acids from fish may have antiarrhythmic effects on atrial muscle. It is unknown if fish intake —or any dietary factor—influences risk of AF.

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Results

Conclusion