Introduction: Several studies have investigated the potential benefits from marine n-3 polyunsaturated fatty acids (PUFA) on cardiovascular disease, generally suggesting a lower risk of coronary heart disease. However, recent trials have questioned these results and clinical guidelines are currently at debate. Hypothesis: This study investigated the association of fish consumption, intake of marine n-3 PUFA and adipose tissue content of marine n-3 PUFA with incident myocardial infarction (MI), expecting to find an inverse relationship. Methods: In a Danish prospective cohort study 57,053 subjects between the age of 50-64 years were enrolled from 1993-97. From national registries we identified all cases of incident MI. Dietary intake of total, fatty and lean fish was assessed using a semi-quantitative food questionnaire, and analyzed in a traditional cohort design. Adipose tissue biopsies were analyzed for all MI-cases and a randomly selected sub-cohort (n=3409). Associations between adipose tissue content of major marine n-3 PUFA and MI were examined using a nested case-cohort design. Results: During a mean follow-up time of 15.9 years, we identified 3,089 cases of incident MI. In both men and women, a high intake of fatty fish (>28 g/day) was inversely related to incident MI. Comparing the highest and lowest quintile, we found a 12 % lower relative risk in men (HR=0.88; 95% CI: 0.77;1.00) and a 24% lower relative risk in women (HR=0.76; 95% CI: 0.61;0.95). Total and lean fish was neutrally associated with MI. Furthermore, high content of EPA and DHA in adipose tissue was negatively associated with incident MI. However, only EPA remained statistically significant after multivariate adjustments with a HR of 0.76 (CI: 0.59;0.98) for men and HR of 0.65 (CI: 0.45;0.94) for women. Conclusions: Incident MI was inversely associated with fatty fish intake and content of EPA in adipose tissue. This study supports the view that consumption of fatty fish may protect against MI.
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