Fish consumption and coronary heart disease mortality in Finland, Italy, and the Netherlands

Fish consumption seems to protect against death from coronary heart disease (CHD). If this association is due to n-3 polyunsaturated fatty acids, espe cially fatty fish may be responsible for this protective effect. The associ ation between total, lean, and fatty fish consumption and the risk of CHD m ortality was examined in 1,088 Finnish, 1,097 Italian, and 553 Dutch men pa rticipants in the Seven Countries Study who were aged 50-69 years and free of CHD around 1970. After 20 years of follow-up, 242 (22.2%) men in Finland , 116 (10.6%) men in Italy, and 105 (19.0%) men in the Netherlands had died of CHD, Cox proportional hazards analysis showed no association between to tal fish consumption and CHD mortality. After adjustments were made for age , body mass index, smoking, energy intake, and relevant dietary variables, the pooled relative risk for the highest quartile of total fish compared wi th no fish consumption in the three countries was 1.08 (95% confidence inte rval: 0.76, 1.53). Lean fish consumption also was not associated with CHD m ortality in any country. Fatty fish compared with non-fatty-fish consumptio n was associated with lower CHD mortality; the adjusted, pooled relative ri sk for fatty fish consumers was 0.66 (95% confidence interval: 0.49, 0.90). These data suggest that especially fatty fish is protective against CHD mo rtality.