Consumption of fish and coronary heart disease (CHD).
Background: Several randomized trials examined the association between fish oil consumption and CHD. Fewer randomized trials examined the relation
with fish consumption. In two trials subjects were randomly allocated to a dietary advice to increase consumption of fatty fish to ≥ 2 portions/week.
Both trials included men from the UK only (The DART study, and the DART II study).
The DART study included men with a history of MI. After 2 years of follow-up, fish advice significantly decreased risk of death from heart disease (Burr ML [9]),
but no long-term benefit was found (Ness AR [9]). The DART II study included men with angina. Fish advice nonsignificantly increased risk of death from
heart disease (Burr ML [25]).
In the past, several systematic reviews were published relating fish consumption to CHD. But lot's of cohorts were excluded from analysis, or not found by
the authors, biasing associations towards a protective effect. Results from these systematic reviews are discussed briefly:
- He K. 2004: Examined the relation with CHD death. 11 cohorts were included, and 7 studies (including data about 5 additional cohorts) were excluded. A total of 3,032 CHD deaths were included. 7 cohorts were not identified/discussed (Hirayama T [10], Dolecek TA [11], Knekt P [13], Gillum RF [17], Pietinen P [18], Whiteman D [21], Nagata C [23]). A strong protective effect was found: RR = 0.62 (0.45-0.82) for consumption ≥ 5 times/week vs < once/month.
- Wang C. 2004: Examined the relation with CHD death. 15 cohorts were included. One cohort was excluded (Norell SE [5]), and 9 cohorts
were not identified/discussed (Vollset SE [3], Hirayama T [10], Knekt P [13], Soinio M [16], Gillum RF [17], Yuan JM [19], Whiteman D [21], Nagata C [23],
Erkkilä AT [28]).
The authors of this review stated that among the large cohort studies, only the Physician's Health Study [15] failed to report a significant beneficial effect of fish consumption. But findings in their own tables contradict this statement. Tables 3.31 and 3.32 show results from prospective studies relating omega-3 fatty acids or fish to cardiac death (pages 65-66). Among the studies larger than the Physician's Health Study, no significant effects at any level of consumption were found in 3 cohorts (Fraser GE [8]; Pietinen P [18]; Egeland GM. 2001). Actually, a significant protective effect of high vs low consumption among the larger cohorts was found in only one cohort (Hu FB [14].
Since a cod liver oil supplement was consumed in one of the cohorts (Egeland GM. 2001), this result was not included in my review examining dietary fish consumption. - König A. 2005: This review only included articles identified by Wang C. (2004) in the review mentioned above.
And the authors wanted to describe the dose-response relationship for fish consumption and CHD death. Studies that limited attention to populations with particular
risk/protective factors were excluded a priori, such as smokers and vegetarians. In addition, several other cohorts were excluded from the analysis, leaving only
6 out of 15 original cohorts (Kromhout D [1], Ascherio [14], Daviglus ML [2], Albert CM [15], Hu FB [14], Mozaffarian D [24]), and one subcohort (Oomen CM [2]),
including a total of 1,927 cases.
The authors of this review found that one servings of fish/week significantly decreased risk of CHD death (- 17%) relative to no consumption, and that each additional serving per week decreased risk incrementally by 3.9%. - Mozaffarian D. 2006: Examined the relation with CHD mortality. Both randomized trials and cohort studies were included. 14 cohorts examining fish intake
were included And 14 cohorts were not identified/discussed (Vollset SE [3], Rodriguez BL [4], Norell SE [5], Hirayama T [10], Järvinen R [13], Salonen JT [16],
Gillum RF [17], Pietinen P [18], Whiteman D [21], Nagata C [23], Erkkilä AT [28], Chang-Claude J [30], Ness AR [31], Nakamura Y [32]).
The authors of this review found a significant protective effect from consumption of 1-2 servings fish/week (- 36%). Within the 14 cohorts included by the authors, a significant protective effect was found in 9 (sub)cohorts. But for "The Health Professionals Follow-up Study" [14] the authors chose to include a more recent publication in which a significant protective effect was found (Mozaffarian D. 2005; 218 cases), while an older publication about this cohort including more cases found absolutely no effect (Ascherio A. 1995; 264 cases). Also, for one of the randomized trials included [9], the authors chose to include data from an older publication in which a strong protective effect was found after 2 years of follow-up (Burr ML. 1989; 194 cases), while a more recent publication showed that no effect was found after > 10 years of follow-up (Ness AR. 2002; 738 cases).
Noticeable is the fact that within the 14 cohorts excluded by the authors, significant protective effects were found in only 2 (sub)cohorts, and that significantly increased risks were found in 2 other cohorts.
|Additional references:
Egeland GM. Cod liver oil consumption, smoking, and coronary heart disease mortality: three counties, Norway. Int J Circumpolar Health. 2001 Apr;60(2):143-9. Abstract
He K. Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation. 2004 Jun 8;109(22):2705-11. Full text
König A. A quantitative analysis of fish consumption and coronary heart disease mortality. Am J Prev Med. 2005 Nov;29(4):335-46. Abstract
Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006 Oct 18;296(15):1885-99. Full text.
Wang C. Effects of omega-3 fatty acids on cardiovascular disease. Evid Rep Technol Assess (Summ). 2004 Mar;(94):1-8. Full text
|
Coronary heart disease risk: Data about total fish consumption was provided by 37 cohorts, including 23,801 cases.
Significant protective effects were found in 4 cohorts (Daviglus ML [2], Dolecek TA [11], Kromhout D [12], Bernstein AM [14]), 3 of which were of
(very) small size (2, 11, 12).
Significant protective effects were also found in 6 subcohorts: IHD among women only, and hypertensive heart disease among men only (Hirayama T [10]),
women only (Järvinen R [13]), MI only (Yuan JM [19]), IHD death only (Mozaffarian D [24], de Goede J [34]), or "referents" only (Tomasallo C [45]).
Four of these cohorts were of (very) small size also (13, 19, 24, 45). These analysis' included 6,393 cases (27% of all cases).
A significantly increased risk was found in one vegetarian cohort of very small size, including 60 cases (Chang-Claude J [30]).
The average RR could be calculated from 31 cohorts: RR = 0.88. Excluding the debatable results from Hirayama T [10], did not change the effect size.
Intermediate levels of consumption: Protective effects were stronger among higher levels of consumption (RR's are 0.95, 0.95, 0.89, and 0.90 for
intakes < 1, 1, 2, and ≥ 3 servings/week, respectively). A more detailed analysis can be found
here.
Effect modification: A detailed analysis can be found
here. Briefly, stratified analysis showed the following effects:
- Protective effects were somewhat stronger among women (RR = 0.84) than among men (RR = 0.90).
- Protective effects were stronger among US (RR = 0.86) and Asian (RR = 0.85) cohorts, than among European (RR = 0.95) cohorts.
- No (consistent) effect modification was found by other factors.
Coronary heart disease mortality: Data about total fish consumption was provided by 33 cohorts, including 15,347 cases.
Significant protective effects were found in 6 cohorts (Daviglus ML [2], Dolecek TA [11], Kromhout D [12], Hu FB [14], Mozaffarian D [24], de Goede J [34]),
4 of which were of (very) small size (2, 11, 12, 24).
Significant protective effects were also found in 4 subcohorts: IHD among women only, and hypertensive heart disease among men only (Hirayama T [10]),
women only (Järvinen R [13]), MI only (Yuan JM [19]), or "referents" only (Tomasallo C [45]). Three of these cohorts were of (very) small size also
(13, 19, 45). These analysis' included 3,715 cases (24% of all cases).
A significantly increased risk was found in one vegetarian cohort of very small size, including 60 cases (Chang-Claude J [30]).
Protective effects were stronger for higher levels of consumption (1.00, 0.93, 0.90, and 0.90 for < 1, 1, 2, and ≥ 3 servings/wk, respectively).
The average RR could be calculated from 29 cohorts: RR = 0.88. Excluding the debatable results from Hirayama T [10], did not change the effect size.
Subjects with prevalent diabetes: In one cohort, a significant protective effect was found among normoglycemic subjects (MR = 0.29), but not among
glucose intolerant subjects (MR = 1.1; Feskens EJ [12]). In another cohort, risk tended to increase among men with diabetes (RR = 1.9), but not among men
without diabetes (RR = 1.1; Morris MC [15]). In a third cohort, the protective effect was stronger among diabetic women (RR = 0.38), than among
nondiabetic
(RR = 0.78; Hu FB [14]).
But no significant effects were found among diabetic subjects in 2 cohorts (Ascherio A [14], Soinio M [16]. And no effect modification by prevalent
diabetes was found in 2 other cohorts (Mozaffarian D [24], Folsom AR [29]).
Subjects with prevalent heart disease: One cohort included subjects with CAD only (Erkkilä AT [28]), and another cohort included subjects
with suspected CAD only (Manger MS [46]). No associations were found with CHD risk or CHD mortality at any level of consumption.
Nonfatal MI: Data about total fish consumption was provided by 7 cohorts, including 2,787 cases.
Significant protective effects were found in 2 cohorts of moderate-large size (Hu FB [14], Iso H [33]), including 1,225 cases (44% of all cases).
And a nonsignificant protective effect was found in a third cohort, which was of very small size (Mozaffarian D [24]). No (non)significantly increased
risks were found. The average RR = 0.79.
Intermediate levels of consumption: Protective effects were stronger among higher levels of consumption (RR's are 0.88, 0.87, 0.80, and 0.78 for
intakes < 1, 1, 2, and ≥ 3 servings/week). A more detailed analysis can be found
here.
No (non)significantly increased risks were found at any level of consumption in any cohort. (non)significant protective effects were as follows:
- 14) Ascherio A (1995). Nonsignificant at 1-3 servings/month, and significant at 2-3 servings/wk.
- 14) Hu FB (2002). Nonsignificant at intake 1-3 times/month, and significant at intake 1-4 times/wk.
- 24) Mozaffarian D (2003). The trend showed a nonsignificant protective effect, but no associations were found at any level of intake.
- 33) Iso H (2006). Significant at 12 servings/wk.
Overlapping effects were found at intake 2-3 servings/wk in 2 cohorts of moderate-large size (Ascherio A [14], Hu FB [14]). These cohorts included 1,583 cases
(57% of all cases).
Heart failure: Data about total fish consumption was provided by 6 cohorts, including 4,319 cases. A significant protective effect was found
in one cohort of very small size, but with a very high prevalence of heart failure (> 20% of the population). No other significant associations
were found, but all RR's were < 1. The average RR = 0.86.
Conclusion: High total fish consumption significantly decreased CHD risk in 10 out of 37 cohorts. But most cohorts were of small size, and protective
effects were often restricted to subcohorts. Inconclusive evidence was found for an association between high vs low consumption of total fish and CHD risk,
but the average effect size (- 12%) does not exclude the possibility of a small protective effect. Stratified analysis shows any small protective effect might
be restricted to US and Asian populations.
High total fish consumption significantly decreased CHD mortality in 10 out of 33 cohorts. But most cohorts were of small size, and protective effects
were sometimes restricted to subcohorts. Inconclusive evidence was found for an association between high vs low consumption of total fish and CHD mortality,
but the average effect size (- 12%) does not exclude the possibility of a small protective effect. For both CHD risk and CHD mortality, effect sizes were
stronger for higher levels of consumption, but similar for intakes of 2 and ≥ 3 servings/week.
High total fish consumption significantly decreased risk of nonfatal MI in 2 cohorts of moderate-large size, but these cohorts included only a minority
of all cases. Suggestive evidence was found that high vs low consumption of total fish is protective against nonfatal MI (- 21%). Analysis of intermediate levels
of consumption showed significant protective effects against nonfatal MI were found in 2 cohorts of moderate-large size at intake 2-3 servings/wk. These cohorts included
the majority of all cases. Consumption of 2-3 servings fish/wk possibly protects against nonfatal MI (- 20 to 22%).
High total fish consumption significantly decreased risk of heart failure in 1 out of 6 cohorts. Inconclusive evidence was found for an association
between high vs low consumption of total fish and risk of heart failure, but the average effect size (- 14%) does not exclude the possibility of a
small protective effect.
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 46) Manger MS (2010) | The WENBIT Study | 210 | Risk | HR = 0.93 (0.63-1.40; P = 0.72) |
| 45) Tomasallo C (2010) | No cohort name defined | 34 captains, and 26 referents | Mortality | Captains: HR = 1.81 (0.53-6.16). Referents: HR = 0.31 (0.10-0.96; P = < 0.05). |
| 44) Holmberg S (2009) | No cohort name defined | 138 | Risk | OR = 1.00 (0.49-2.06) |
| 38) Kaushik S (2008) | The Blue Mountains Eye Study | 184 | Mortality | HR = 0.91 (0.64-1.28) |
| 36) Yamagishi K (2008) | The JACC Study | 419 IHD, 107 cardiac arrest, and 307 heart failure | Mortality | IHD: HR = 0.86 (0.62-1.19; P = 0.41). Cardiac arrest: HR = 0.73 (0.36-1.46; P = 0.16). Heart failure: HR = 0.76 (0.53-1.07; P = 0.10). |
| 34) de Goede J (2010) | The Dutch part of the EPIC Study | 82 CHD mortality, and 252 nonfatal MI | Risk | CHD mortality: HR = 0.52 (0.28-0.95; P = 0.02). Nonfatal MI: HR = 1.01 (0.71-1.45; P = 0.14). |
| 34) Bjerregaard LJ (2010) | The Danish part of the EPIC Study | 854 men, and 268 women | Risk | Men: HR = 0.87 (0.69-1.10). Women: HR = 0.85 (0.55-1.32). |
| 34) Buckland G (2009) | The Spanish part of the EPIC Study | 606 | Risk | HR = 0.83 (0.68-1.02; P = 0.82) |
| 33) Iso H (2006) | The JPHC Study | 258 | Risk | HR = 0.63 (0.38-1.04; P = 0.25) |
| 32) Nakamura Y (2005) | The NIPPON DATA80 | 124 | Mortality | RR = 0.86 (0.33-2.23; P = 0.51) for the highest vs second quintile of consumption (RR reference group = 1.45). |
| 31) Ness AR (2005) | The Boyd Orr Cohort | 298 | Mortality | RR = 1.18 (0.80-1.76; P = 0.6) |
| 30) Chang-Claude J (2005) | The German Vegetarian Study | 60 | Mortality | RR = 2.11 (1.13-3.96; P = 0.03) |
| 29) Folsom AR (2004) | The Iowa Women's Health Study | 922 | Mortality | RR = 1.04 (0.80-1.34; P = 0.31) |
| 28) Erkkilä AT (2003) | The EUROASPIRE Study | 34 | Risk | RR = 0.49 (0.17-1.41; P = 0.21) |
| 26) Osler M (2003) | No cohort name defined | 491 | Risk | HR = 0.93 (0.68-1.27; P = 0.55) for the highest vs third quartile of consumption (RR reference group = 1.02) |
| 24) Mozaffarian D (2003) | The Cardiovascular Health Study | 247 IHD death, and 363 nonfatal MI | Risk | IHD death: HR = 0.47 (0.27-0.82; P = 0.002). Nonfatal MI: HR = 0.67 (0.42-1.07; P = 0.10). |
| 23) Nagata C (2002) | The Takayama Study | 63 men, and 52 women | Mortality | Men: HR = 1.05 (0.56-1.97; P = 0.91). Women: HR = 0.73 (0.37-145; P = 0.37). |
| 22) Wennberg M (2011) | The NSHDS | 263 | Risk | OR = 1.21 (0.43-3.33; P = 0.52) |
| 21) Whiteman D (1999) | The OXCHECK Study | 93 | Mortality | RR = 1.36 (0.57-3.25) |
| 20) Mann JI (1997) | The Oxford Vegetarian Study | 64 | Mortality | DRR = 123 (70-217; P = NS) |
| 19) Yuan JM (2001) | The Shanghai Cohort Study | 113 MI, and 74 other IHD | Mortality | MI: RR = 0.35 (0.17-0.72; P = 0.02). Other IHD: RR = 0.92 (0.41-2.06; P = 0.34). |
| 18) Pietinen P (1997) | The ATBC Study | 635 | Mortality | RR = 1.12 (0.87-1.45; P = 0.09) |
| 17) Gillum RF (2000) | The NHANES I Study | Not defined (2,007 total) | Risk | White men: RR = 0.86 (0.65-1.13). Black men: RR = 1.05 (0.50-2.19). White women: RR = 0.97 (0.74-1.28). Black women: RR = 0.90 (0.51-1.60). |
| 16) Soinio M (2003) | No cohort name defined | 117 | Risk | No significant association |
| 15) Albert CM (1998) | The Physician's Health Study | 737 | Risk | RR = 1.00 (0.62-1.60; P = 0.67) |
| 14) Bernstein AM (2010) | The Nurses' Health Study | 3,162 | Risk | RR = 0.81 (0.72-0.90; P = < 0.001) |
| 14) Ascherio A (1995) | The Health Professionals Follow-up Study | 811 | Risk | RR = 0.90 (0.63-1.28; P = 0.70) |
| 13) Järvinen R (2006) | The Finnish Mobile Clinic Health Survey | 335 men, and 163 women | Mortality | Men: RR = 1.00 (0.70-1.43; P = 0.83). Women: RR = 0.59 (0.36-0.99; P = 0.02). |
| 12) Kromhout D (1995) | No cohort name defined | 58 | Mortality | RR = 0.51 (0.29-0.89) |
| 11) Dolecek TA (1992) | The Multiple Risk Factor Intervention Trial | 175 | Mortality | RR = 0.61 (P = < 0.05) |
| 10) Hirayama T (1990) | No cohort name defined | IHD: 2,170 men, and 1,378 women. Hypertensive heart disease: 559 men, and 613 women. Rheumatic heart disease: 364. Other heart disease: not defined | Mortality | IHD: RR's for low vs high consumption are 1.20 (0.76-1.90) for men, and 1.49 (1.02-2.19) for women. Hypertensive heart disease: RR's for low vs high consumption are 2.14 (1.07-4.27) for men, and 0.52 (0.20-1.31) for women. Rheumatic heart disease: RR = 0.95 (0.79-1.14). Other heart disease: RR's for low vs high consumption are 1.02 (0.60-1.75) for men, and 1.36 (0.97-1.92) for women. |
| 8) Fraser GE (1992) | The Adventist Health Study | 134 nonfatal MI, and 463 CHD death | Risk | Nonfatal MI: RR = 1.04 (0.55-1.96). CHD death: RR = 1.09 (0.73-1.61). |
| 7) Tanaka H (1987) | The Shibata Study | not defined | Risk | RR = 1.23 |
| 6) Lapidus L (1986) | No cohort name defined | 23 | Risk | No significant association |
| 5) Norell SE (1986) | The Cohort of Swedish Twins | 800 | Mortality | RR = 0.85 (0.69-1.06) |
| 4) Rodriguez BL (1996) | The Honolulu Heart Program | not defined | Risk | No significant association |
| 3) Vollset SE (1985) | No cohort name defined | 967 | Mortality | No significant association (P = 0.93) |
| 2) Daviglus ML (1997) | The Western Electric Study | 430 | Mortality | RR = 0.62 (0.40-0.94; P = 0.04) |
| 1) Streppel MT (2008) | The Dutch part of the Seven Countries Study | 336 | Mortality | HR = 0.73 (0.47-1.13; P = 0.16) |
| 1) Oomen CM (2000) | The Finnish & Italian part of the Seven Countries Study | 242 Finland, and 116 Italy | Mortality | Finland: RR = 1.25 (0.89-1.76; P = 0.20). Italy: RR = 0.67 (0.33-1.39; P = 0.33). |
| Total number of cases: 23,801 | Average RR = 0.88 | |||
| Excluding data from Hirayama T [10]. | Total number of cases: 18,717 | Average RR = 0.88 |
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 46) Manger MS (2010) | The WENBIT Study | 76 | CHD | HR = 1.03 (0.54-1.94; P = 0.94) |
| 45) Tomasallo C (2010) | No cohort name defined | 34 captains, and 26 referents | CHD | Captains: HR = 1.81 (0.53-6.16). Referents: HR = 0.31 (0.10-0.96; P = < 0.05) |
| 38) Kaushik S (2008) | The Blue Mountains Eye Study | 184 | CHD | HR = 0.91 (0.64-1.28) |
| 36) Yamagishi K (2008) | The JACC Study | 419 IHD, 107 cardiac arrest, and 307 heart failure | IHD, cardiac arrest, and heart failure | IHD: HR = 0.86 (0.62-1.19; P = 0.41). Cardiac arrest: HR = 0.73 (0.36-1.46; P = 0.16). Heart failure: HR = 0.76 (0.53-1.07; P = 0.10). |
| 34) de Goede J (2010) | The Dutch part of the EPIC Study | 82 | CHD | HR = 0.52 (0.28-0.95; P = 0.02) |
| 33) Iso H (2006) | The JPHC Study | 62 | CHD | HR = 1.08 (0.42-2.76; P = 0.31) |
| 32) Nakamura Y (2005) | The NIPPON DATA80 | 124 | CHD | RR = 0.86 (0.33-2.23; P = 0.51) for the highest vs second quintile of consumption (RR reference group = 1.45) |
| 31) Ness AR (2005) | The Boyd Orr Cohort | 298 | CHD | RR = 1.18 (0.80-1.76; P = 0.6) |
| 30) Chang-Claude J (2005) | The German Vegetarian Study | 60 | IHD | RR = 2.11 (1.13-3.96; P = 0.03) |
| 29) Folsom AR (2004) | The Iowa Women's Health Study | 922 | CHD | RR = 1.04 (0.80-1.34; P = 0.31) |
| 28) Erkkilä AT (2003) | The EUROASPIRE Study | 16 | CAD | RR = 1.04 (0.25-4.31; P = 0.73) |
| 26) Osler M (2003) | No cohort name defined | 247 | CHD | HR = 0.98 (0.62-1.52; P = 0.74) for the highest vs third quartile of consumption (RR reference group = 1.09). |
| 24) Mozaffarian D (2003) | The Cardiovascular Health Study | 247 | IHD | HR = 0.47 (0.27-0.82; P = 0.002) |
| 23) Nagata C (2002) | The Takayama Study | 63 men, and 52 women | IHD | Men: HR = 1.05 (0.56-1.97; P = 0.91). Women: HR = 0.73 (0.37-145; P = 0.37). |
| 21) Whiteman D (1999) | The OXCHECK Study | 93 | IHD | RR = 1.36 (0.57-3.25) |
| 20) Mann JI (1997) | The Oxford Vegetarian Study | 64 | IHD | DRR = 123 (70-217; P = NS) |
| 19) Yuan JM (2001) | The Shanghai Cohort Study | 113 MI, and 74 other IHD | MI, and other IHD | MI: RR = 0.35 (0.17-0.72; P = 0.02). Other IHD: RR = 0.92 (0.41-2.06; P = 0.34). |
| 18) Pietinen P (1997) | The ATBC Study | 635 | CHD | RR = 1.12 (0.87-1.45; P = 0.09) |
| 17) Gillum RF (2000) | The NHANES I Study | 752 | CHD | No significant association |
| 16) Soinio M (2003) | No cohort name defined | 65 | CHD | No significant association |
| 15) Albert CM (1998) | The Physician's Health Study | 308 | CHD | RR = 0.81 (0.41-1.61; P = 0.49) |
| 14) Hu FB (2002) | The Nurses' Health Study | 484 | CHD | RR = 0.55 (0.33-0.90; P = 0.01) |
| 14) Ascherio A (1995) | The Health Professionals Follow-up Study | 264 | CHD | RR = 0.77 (0.41-1.44; P = 0.14) |
| 13) Järvinen R (2006) | The Finnish Mobile Clinic Health Survey | 335 men, and 163 women | CHD | Men: RR = 1.00 (0.70-1.43; P = 0.83). Women: RR = 0.59 (0.36-0.99; P = 0.02). |
| 12) Kromhout D (1995) | No cohort name defined | 58 | CHD | RR = 0.51 (0.29-0.89) |
| 11) Dolecek TA (1992) | The Multiple Risk Factor Intervention Trial | 175 | CHD | RR = 0.61 (P = < 0.05) |
| 10) Hirayama T (1990) | No cohort name defined | IHD: 2,170 men, and 1,378 women. Hypertensive heart disease: 559 men, and 613 women. Rheumatic heart disease: 364. Other heart disease: not defined | IHD, hypertensive heart disease, rheumatic heart disease, and other heart disease | IHD: RR's for low vs high consumption are 1.20 (0.76-1.90) for men, and 1.49 (1.02-2.19) for women. Hypertensive heart disease: RR's for low vs high consumption are 2.14 (1.07-4.27) for men, and 0.52 (0.20-1.31) for women. Rheumatic heart disease: RR = 0.95 (0.79-1.14). Other heart disease: RR's for low vs high consumption are 1.02 (0.60-1.75) for men, and 1.36 (0.97-1.92) for women. |
| 8) Fraser GE (1992) | The Adventist Health Study | 463 | CHD | RR = 1.09 (0.73-1.61) |
| 5) Norell SE (1986) | The Cohort of Swedish Twins | 800 | CHD | RR = 0.85 (0.69-1.06) |
| 4) Rodriguez BL (1996) | The Honolulu Heart Program | not defined | CHD | lowest 2 tertiles of smoking: no significant association. highest tertile of smoking: RR = 0.50 (0.28-0.91). |
| 3) Vollset SE (1985) | No cohort name defined | 967 | CHD | No significant association (P = 0.93) |
| 2) Daviglus ML (1997) | The Western Electric Study | 430 | CHD | RR = 0.62 (0.40-0.94; P = 0.04) |
| 1) Streppel MT (2008) | The Dutch part of the Seven Countries Study | 336 | CHD | HR = 0.73 (0.47-1.13; P = 0.16) |
| 1) Oomen CM (2000) | The Finnish & Italian part of the Seven Countries Study | 242 Finland, and 116 Italy | CHD | Finland: RR = 1.25 (0.89-1.76; P = 0.20). Italy: RR = 0.67 (0.33-1.39; P = 0.33). |
| Total number of cases: 15,347 | Average RR = 0.88 | |||
| Excluding data from Hirayama T [10]. | Total number of cases: 10,263 | Average RR = 0.88 |
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 34) de Goede J (2010) | The Dutch part of the EPIC Study | 252 | Nonfatal MI | HR = 1.01 (0.71-145; P= 0.14) |
| 33) Iso H (2006) | The JPHC Study | 196 | Nonfatal CHD | HR = 0.43 (0.23-0.81; P = 0.02) |
| 24) Mozaffarian D (2003) | The Cardiovascular Health Study | 363 | Nonfatal MI | HR = 0.67 (0.42-1.07; P = 0.10) |
| 15) Morris MC (1995) | The Physician's Health Study | 259 | Nonfatal MI | RR = 0.8 (0.4-1.7; P = 0.79) |
| 14) Hu FB (2002) | The Nurses' Health Study | 1,029 | Nonfatal MI | RR = 0.73 (0.51-1.04; P = 0.03) |
| 14) Ascherio A (1995) | The Health Professionals Follow-up Study | 554 | Nonfatal MI | RR = 0.96 (0.63-1.47; P = 0.62) |
| 8) Fraser GE (1992) | The Adventist Health Study | 134 | Nonfatal MI | RR = 1.04 (0.55-1.96) |
| Total number of cases: 2,787 | Average RR = 0.79 |
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 43) Dijkstra CS (2009) | The Rotterdam Study | 669 | Risk | RR = 0.96 (0.78-1.18; P = 0.39) |
| 42) Levitan EB (2010) | The Swedish Mammography Cohort | 651 | Risk | RR = 0.81 (0.63-1.05) |
| 42) Levitan EB (2009) | The Cohort of Swedish Men | 597 | Risk | HR = 0.89 (0.60-1.33) |
| 39) Nettleton JA (2008) | The ARIC Study | 1,140 | Risk | RR = 0.99 (0.81-1.22) |
| 36) Yamagishi K (2008) | The JACC Study | 307 | Mortality | HR = 0.76 (0.53-1.07; P = 0.10). |
| 24) Mozaffarian D (2005) | The Cardiovascular Health Study | 955 | Risk | HR = 0.68 (0.45-1.03; P = 0.009) |
| Total number of cases: 4,319 | Average RR = 0.86 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 46) Manger MS (2010) | The Western Norway B Vitamin Intervention Trial (WENBIT) | 2,412 men and women aged > 18, and undergoing coronary angiography for suspected CAD and/or aortic valve stenosis. Nearly 90% of the participants used statins. | 1999-2004 to 2006 | See variables | Coronary events | Fish (tinned mackerel in tomato paste-, smoked mackerel-, sardines-, pickled herring-, anchovies-, or similar-, and salmon or trout on bread; fish cakes, fish pudding or fish balls; fish fingers; boiled cod, coalfish, or haddock; fried cod, coalfish, or haddock; fresh, salted-cured, or smoked herring; fresh or smoked mackerel, salmor or trout [wild or farmed]; fish stew, fish soup, or fish au gratin; and shrimp or crab) |
Age, sex, left venticular ejection fraction, diabetes mellitus, hypertension, current smoker, acute coronary syndrome, and current use of statins. |
The association did not change after additional adjustment for BMI, serum triglycerides, previous AMI, previous PCI, previous CABG, previous cerebrovascular disease or carotid artery stenosis, previous peripheral arterial disease, extend of CAD, current us of beta-blockers, current use of angiotensin-converting enzyme inhibitors, and dietary intakes of saturated fatty acids, n-6 fatty acids, fiber, alpha-linolenic acid, thiamine, riboflavin, and tocopherol. 46) Manger MS (2010) | The Western Norway B Vitamin Intervention Trial (WENBIT) | 2,412 men and women aged > 18, and undergoing coronary angiography for suspected CAD and/or aortic valve stenosis. Nearly 90% of the participants used statins. | 1999-2004 to 2006 | 76 | Coronary death | Fish (tinned mackerel in tomato paste-, smoked mackerel-, sardines-, pickled herring-, anchovies-, or similar-, and salmon or trout on bread; fish cakes, fish pudding or fish balls; fish fingers; boiled cod, coalfish, or haddock; fried cod, coalfish, or haddock; fresh, salted-cured, or smoked herring; fresh or smoked mackerel, salmor or trout [wild or farmed]; fish stew, fish soup, or fish au gratin; and shrimp or crab) |
HR = 1.03 (0.54-1.94; P = 0.94) for the highest vs lowest quartile of consumption. | Amount specific data (g): 41.1: HR = 1. 81.4: HR = 0.79 (0.42-1.51). 118.0: HR = 0.83 (0.44-1.56). 198.0: HR = 1.03 (0.54-1.94). Age, sex, left venticular ejection fraction, diabetes mellitus, hypertension, current smoker, acute coronary syndrome, and current use of statins. |
The association did not change after additional adjustment for BMI, serum triglycerides, previous AMI, previous PCI, previous CABG, previous cerebrovascular disease or carotid artery stenosis, previous peripheral arterial disease, extend of CAD, current us of beta-blockers, current use of angiotensin-converting enzyme inhibitors, and dietary intakes of saturated fatty acids, n-6 fatty acids, fiber, alpha-linolenic acid, thiamine, riboflavin, and tocopherol. 46) Manger MS (2010) | The Western Norway B Vitamin Intervention Trial (WENBIT) | 2,412 men and women aged > 18, and undergoing coronary angiography for suspected CAD and/or aortic valve stenosis. Nearly 90% of the participants used statins. | 1999-2004 to 2006 | 298 | Stable angina with angiographic progression of CAD | Fish (tinned mackerel in tomato paste-, smoked mackerel-, sardines-, pickled herring-, anchovies-, or similar-, and salmon or trout on bread; fish cakes, fish pudding or fish balls; fish fingers; boiled cod, coalfish, or haddock; fried cod, coalfish, or haddock; fresh, salted-cured, or smoked herring; fresh or smoked mackerel, salmor or trout [wild or farmed]; fish stew, fish soup, or fish au gratin; and shrimp or crab) |
HR = 1.34 (0.97-1.85; P = 0.23) for the highest vs lowest quartile of consumption. | Amount specific data (g): 41.1: HR = 1. 81.4: HR = 1.24 (0.89-1.72). 118.0: HR = 0.93 (0.66-1.32). 198.0: HR = 1.34 (0.97-1.85). Age, sex, left venticular ejection fraction, diabetes mellitus, hypertension, current smoker, acute coronary syndrome, and current use of statins. |
The association did not change after additional adjustment for BMI, serum triglycerides, previous AMI, previous PCI, previous CABG, previous cerebrovascular disease or carotid artery stenosis, previous peripheral arterial disease, extend of CAD, current us of beta-blockers, current use of angiotensin-converting enzyme inhibitors, and dietary intakes of saturated fatty acids, n-6 fatty acids, fiber, alpha-linolenic acid, thiamine, riboflavin, and tocopherol. 45) Tomasallo C (2010) | Cohort name not defined | 2 cohorts were formed: | -2,123 captains/spouses, and anglers. -1,367 referents. (USA) 12 | (1995-2006) See variables | Coronary heart disease mortality | Total fish (captains were frequent consumers of fish from the Great Lakes, while referents did not consume fish from the Great Lakes, but ate commercial fish) |
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The size of the fish meal or number of ounces consumed was not obtained. Sex, age, BMI, and income. |
44) Holmberg S (2009) | No cohort name defined | 1,752 farmers and non-farming rural men without a history of CHD. | (Sweden) 12 | (1990-91 to 2002-03) 138 | Coronary heart disease risk (hospitalized or deceased due to CHD) | Fish (not defined) | OR = 1.00 (0.49-2.06) for consumption ≥ vs < twice a week. | Age, BMI, LDL, systolic blood pressure, physical workload, smoking, bread, and a dairy fat-vegetable/fruit interaction. |
43) Dijkstra CS (2009) | The Rotterdam Study | 5,299 subjects (2,164 men and 3,135 women) aged ≥ 55, and free from heart failure. | (The Netherlands) 11.4 | (1990-93 to 2006) 669 | Heart failure incidence (presence of at least 2 signs [shortness of breath, ankle oedema, and pulmonary crepitations] or use of medication for heart failure) | Fish (eaten as a hot meal, on a sandwich, or between meals) |
RR = 0.96 (0.78-1.18; P = 0.39) for the highest vs lowest tertile of consumption. | Amount specific data (g/day): 0: RR = 1. 1-19: RR = 1.15 (0.96-1.39). ≥ 20: RR = 0.96 (0.78-1.18). Age, sex, total energy intake, smoking, education, and intake of alcohol, fat, saturated fat, trans-fat and meat. |
42) Levitan EB (2010) | The Swedish Mammography Cohort | 36,234 women without HF, MI, or diabetes. | 1998-2006 | 651 | Heart failure events (hospitalization for or death from hf) | Marine omega-3 (the sum of EPA, and DHA from food sources) |
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Results did not differ materially when fatty acids from fish oil supplements were included in the calculation. Age, education, BMI, physical activity, cigarette smoking, living alone, postmenopausal hormone use, total energy intake, alcohol intake, fiber intake, sodium intake, intake of red or processed meat, family history of MI, history of hypertension, history of high cholesterol, and protein, saturated fat, monounsaturated fat, non-marine omega 3 fatty acids, and omega 6 fatty acids. |
42) Levitan EB (2009) | The Cohort of Swedish Men | 39,367 men aged 45-79, without a history of cancer, heart failure, MI, or diabetes. | 1998-2004 | 597? | Heart failure incidence (hospitalization for or death from HF) | Total fish (herring/mackerel, salmon/whitefish/char, cod/saithe/fishfingers, caviar, and shellfish including shrimp) |
HR = 0.89 (0.60-1.33) for the highest vs lowest quintile of consumption. | Amount specific data (Servings): < 1/week: HR = 1. 1/week: HR = 0.78 (0.57-1.08). 2/week: HR = 0.80 (0.58-1.11). 3-6/week: HR = 0.76 (0.54-1.06). ≥ 1/day: HR = 0.89 (0.60-1.33). Age, BMI, physical activity, energy, alcohol, fibre, sodium, and red or processed meat consumption, education, family history of MI, cigarette smoking, marital status, history of hypertension, and high cholesterol. |
42) Levitan EB (2009) | The Cohort of Swedish Men | 39,367 men aged 45-79, without a history of cancer, heart failure, MI, or diabetes. | 1998-2004 | 597 | Heart failure incidence (hospitalization for or death from HF) | Marine omega-3 fatty acids (the sum of EPA and DHA from food sources) |
|
Age, BMI, physical activity, energy, alcohol, fibre, sodium, and red or processed meat consumption, education, family history of MI, cigarette smoking, marital status, history of hypertension, and high cholesterol. |
Further adjustment for macronutrients did not materially change the results. 39) Nettleton JA (2008) | The Atherosclerosis Risk In Communities (ARIC) Study. | 14,153 African-American and white adults age 45-64. | (USA) 13.3 | (1987-89 to 2003) 1,140? (639 men, 501 women) | Incident heart failure | Fish (seafood, dark-meat fish, tuna, other fish) | RR = 0.99 (0.81-1.22; No P-value) for a 1 serving/d difference. | There were no significant interactions between dietary intake variables and BMI, sex, race, or baseline disease status (CVD, diabetes, or hypertension) (data not shown). Energy intake, age, sex, race/center, education level, physical activity level, smoking status, drinking status, and prevalent disease (cardiovascular disease, diabetes, and hypertension). |
38) Kaushik S (2008) | The Blue Mountains Eye Study (BMES) | 2,683 predominantly Caucasian subjects aged 49+ | 10 | (1992-94 to ?) 184 | CHD death | Any fish (not defined) |
HR = 0.91 (0.64-1.28) for the highest vs lowest tertile of consumption. | Amount specific data (Frequency of consumption/week): < 1: HR = 1. 1: HR = 0.88 (0.60-1.28). ≥ 2: HR = 0.91 (0.64-1.28). Age, gender, mean arterial blood pressure, BMI, smoking status, qualification level, self-rated health and past history of MI and stroke. |
36) Yamagishi K (2008) | The JACC Study | 57,972 subjects (22,881 men and 35,091 women) aged 40-79, and without heart disease, stroke, or cancer. | (Japan) 12.7 | (1988-90 to 1999-2003) See variables | CHD mortality | Fish (fresh fish, kamaboko [steamed fish paste], dried or salted fish, and deep-fried foods or tempura [a common form of deep-fried fish or shellfish]) |
|
No differences were found by gender in any association. Energy, history of hypertension and diabetes mellitus, smoking status, alcohol consumption, BMI, mental stress, walking, sports, education, total energy, dietary intakes of cholesterol, saturated and omega 6 polyunsaturated fatty acids, vegetables, and fruits. |
36) Iso H (2007) | The JACC Study | 43,918 men, and 59,796 women. | (Japan) Not defined. | 617 men, and | 406 women. Ischemic heart disease mortality | Fresh fish (not defined) |
|
Age and study area. |
34) de Goede J (2010) | The Monitoring Project on Risk Factors for Chronic Diseases (MORGEN). | (A contribution to the Dutch part of the EPIC Study) 21,342 men and women aged 20-65, and without MI or stroke. | (The Netherlands) 11.3 | (1993-97 to 2007) See variables | CHD | Fish (lean and moderately fatty fish [including plaice, cod, fried fish, fish fingers]; fatty fish [including eel, mackerel, herring]; and shrimps and mussels) |
|
The consumption of lean/moderately fatty fish was 3-4 times as high as the consumption of fatty fish. Effect modification: Stratified analyses did not provide evidence for interaction by gender or age (data not shown). Age, gender, BMI, total energy intake, ethanol intake, cigarette smoking, social economic status, vitamin or mineral supplement use, use of drugs for hypertension or hypercholesterolemia, family history of CVD, SFA, fruit, and vegetables. |
Additional adjustment for monounsaturated fatty acids, linoleic acid, and alpha-linolenic acid yielded similar results (data not shown). 34) Joensen AM (2010) | The Danish Diet, Cancer and Health Cohort | 55,434 men and women aged 50-64, and without unstable angina pectoris, MI, or cancer. | 7.6 | (1993-97 to 2004) 1,124? | Acute coronary syndrome (62 unstable angina pectoris, 885 non-fatal MI and 177 fatal MI) | Marine n-3 PUFA (not defined, but excluding fish oil capsules) |
|
Smoking, BMI, time of moderate to vigorous physical activity, history of diabetes mellitus, systolic blood pressure, total cholesterol, alcohol consumption, total intake of fruit, vegetables, saturated fat, monounsaturated fat and n-6 PUFA, and for women HRT. |
34) Bjerregaard LJ (2010) | The Diet, Cancer and Health Cohort | 54,226 subjects (25,573 men and 28,653 women) aged 50-64, and without acute coronary syndrome or cancer. | (Denmark) 7.6 | (1993-97 to 2003) 854 men, and 268 women | Acute coronary syndrome (excluding sudden deaths without symptoms of coronary origin) | Total fish (tuna, sardines, plaice/flounder, col/pollack, garfish, cod roe, shrimps, herring, mackerel, salmon/trout/char, and caviar [Danish]) |
|
Fatal MI: Associations with fatal MI (175 cases) were similar, but the CIs were wider and not significant (data not shown). Effect modification: Stratification according to intake of fish oil capsules did not significantly change the risk estimates (data not shown). Education, smoking, alcohol intake, BMI, history of diabetes mellitus, systolic blood pressure, serum cholesterol, physical activity, dietary intake of fruits and vegetables, total energy intake, dietary intake of saturated fat, mononunsaturated fat, and polyunsaturated fat, and menopausal status. |
34) Buckland G (2009) | The Spanish EPIC Cohort Study | 40,757 subjects (15,335 men and 25,422 women) aged 29-69 and free of coronary events. | 10.4 | (1992-96 to 2004) See variables | CHD incidence (fatal or nonfatal myocardial infarction or unstable angina requiring revascularization) | Fresh fish (including seafood, excluding preserved and processed fish) |
|
Stratified by center and age. |
Adjusted for education, physical activity, BMI, smoking status, diabetes, hypertension, and hyperlipidemia status, and total calorie intake. 33) Iso H (2006) | The JPHC Study Cohort I | 41,578 subjects (19,985 men and 21,593 women) aged 40-59, and free of CVD and cancer. | (Japan) 1990-92 to 2001 | See variables | Coronary heart disease incidence | Fish (not defined, but including fresh fish, dried or salted fish, salted fish roe, and salted fish preserves) |
|
Age, sex, cigarette smoking, alcohol intake, BMI, histories of hypertension and diabetes, medication use for hypercholesterolemia, education level, sports at leisure time, intake of fruits, vegetables, saturated fat, monounsaturated fat, n6 polyunsaturated fat, cholesterol, total energy, and PHC. |
32) Nakamura Y (2005) | The NIPPON DATA80 | 8,879 subjects (3,945 men, and 4,934 women) aged ≥ 30, and without coronary disease, stroke, cancer, or significant comorbidities such as renal insufficiency. | (Japan) 19 | (1980-1999) 124 | Coronary heart disease death | Fish (not defined) |
RR = 0.86 (0.33-2.23; P = 0.51) for the highest vs second quintile of consumption. | Amount specific data (Frequency of consumption): < 1/wk: RR = 1.45 (0.62-3.37). 1-2/wk: RR = 1 (Reference group). 1/2 day: RR = 1.10 (0.67-1.80). 1/day: RR = 0.90 (0.50-1.61). ≥ 2/day: RR = 0.86 (0.33-2.23). Additional adjustment for serum total cholesterol did not change the association. Age, sex, smoking, alcohol drinking, hypertension, BMI, and diabetes. |
31) Ness AR (2005) | The Boyd Orr Cohort | 4,028 people (1,995 men, and 2,033 women) from England and Scotland. | average 37 | (1948 to 2000) 298 | CHD mortality | Fish (not defined) |
RR = 1.18 (0.80-1.76; P = 0.6) for the highest vs lowest quartile of consumption. | Amount specific data (g): 0-6.9: RR = 1. 7.0-15.7: RR = 0.99 (0.68-1.43). 15.8-29.2: RR = 0.85 (0.58-1.25). 29.2-148.9: RR = 1.18 (0.80-1.76). Age, energy, sex, childhood family food expenditure, father's social class, district of residence as a child, period of birth, season when studied as a child, and Townsend score for current address or place of death. |
30) Chang-Claude J (2005) | The German Vegetarian Study | 1,724 vegetarians and health conscious persons. | 21 | (1978-1999) 60 | Ischemic heart disease mortality | Fish (not defined) |
RR = 2.11 (1.13-3.96; P = 0.03) for the highest vs lowest tertile of consumption. | Amount specific data: Never: RR = 1. ≤ once a month: RR = 1.11 (0.56-2.23). > once a month: RR = 2.11 (1.13-3.96). Age, gender, smoking, level of activity, alcohol consumption, BMI, and education. |
29) Kelemen LE (2005) | The Iowa Women's Health study | 29,017 postmenopausal women aged 55-69. | (USA) 15 (1986-2000) | 739? | Coronary heart disease mortality | Fish (fresh fish, canned fish, and seafood) | RR = 1.12 (0.86-1.46; P = 0.95) for the highest vs lowest quintile (median servings per 1,000 kcal between extreme quintiles = 0 and 0.28) of substitution for an isoenergetic amount of all carbohydrate-rich foods* | Amount specific data (quintiles. No amounts specified): Q1: RR = 1. Q2: RR = 0.89. Q3: RR = 0.82. Q4: RR = 0.76. Q5: RR = 1.12. *Carbohydrate rich foods [defined as: A composite of refined carbohydrates (rice, pasta, potatoes, refined cold breakfast cereal, muffins, snack foods, sweetened sodas, pizza, chocolate, candy, cakes, cookies, donuts, pastries, pies) and whole-grain carbohydrates (dark bread, brown rice, oatmeal, whole-grain breakfast cereal, bran, wheat germ, and other grains such as bulgar, kasha, and couscous)]. Age, total energy, saturated fat, polyunsaturated fat, monounsaturated fat, trans-fat, total fiber, dietary cholesterol, dietary methionine, alcohol, smoking, activity level, BMI, history of hypertension, postmenopausal hormone use, multivitamin use, vitamin E supplement use, education, family history of cancer, servings of fruits and vegetables excluding potatoes, legumes, dairy, eggs, red meats, poultry, and fish. |
29) Folsom AR (2004) | The Iowa Women's Health Study | 41,836 women aged 55-69, and free of heart disease or cancer. | 1986-2000 | Women initially free of heart disease: 922. | Diabetic women: ? Coronary heart disease mortality | Total fish and seafood (Dark-meat fish [such as mackerel, salmon, sardines, bluefish, or swordfish]; Canned tuna; Other fish;, and Shrimp, lobster, or callops as a main dish) |
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Age, energy intake, education level, physical activity level, alcohol consumption, smoking status, pack-years of cigarette smoking, age at first livebirth, estrogen use, vitamin use, BMI, waist/hip ratio, diabetes, hypertension, intake of whole grains, fruits and vegetables, red meat, cholesterol, and saturated fat. |
29) Folsom AR (2004) | The Iowa Women's Health Study | 41,836 women aged 55-69, and free of heart disease or cancer. | 1986-2000 | 922? | Coronary heart disease mortality | Omega-3 fatty acids from fish (excluding fish oil supplements) | No association was found (results not shown). | Age, energy intake, education level, physical activity level, alcohol consumption, smoking status, pack-years of cigarette smoking, age at first livebirth, estrogen use, vitamin use, BMI, waist/hip ratio, diabetes, hypertension, intake of whole grains, fruits and vegetables, red meat, cholesterol, and saturated fat. |
28) Erkkilä AT (2003) | The Finnish cohort of the EUROASPIRE Study | 400 subjects aged 33-74 with CAD admitted to Kuopio University Hospital. | 5 | CAD death: 16 | CAD death or AMI: 34 CAD | Fish (not defined) |
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Age, sex, diagnostic category, energy intake, serum cholesterol, serum triaglycerol, diabetes, BMI, and education. |
28) Erkkilä AT (2003) | The Finnish cohort of the EUROASPIRE Study | 400 subjects aged 33-74 with CAD admitted to Kuopio University Hospital. | 5 | 38 | Revascularization | Fish (not defined) |
RR = 1.09 (0.37-3.17; P = 0.226) for the highest vs lowest tertile of consumption. | Amount specific data (g/d): 0: RR = 1. 1-57: RR = 1.89 (0.68-5.25). > 57: RR = 1.09 (0.37-3.17). Age, sex, diagnostic category, energy intake, serum cholesterol, serum triaglycerol, diabetes, BMI, and education. |
26) Osler M (2003) | No cohort name defined | 4,513 men and 3,984 women aged 30-70. | (Denmark) (1982-92 to 1997) | See variables | CHD | Fish (not defined) |
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High risk individuals: (men over 50 years or women over 60 years, who were current smokers with serum cholesterol over 6 mmol/L or current nonsmokers with a serum cholesterol over 7 mmol/L). Effect modification: In men, serum cholesterol modified the association between fish intake and CHD risk (P = .03 for the interaction term). In those with low serum cholesterol (less than 5 mmol/L) the CHD risk was lowest for those eating fish once a week, while among men with cholesterol levels over 7 mmol/L the risk of CHD were highest for those eating fish once a week. In women, educational level modified the association between fish intake and CHD (P = .02 for the interaction term). Thus, in the least educated women frequent fish intake was associated with a reduced risk of CHD, although this was not the case in more educated women (data not shown). Familial predisposition, smoking status, physical activity, alcohol, educational status, healthy diet score, total cholesterol, BMI. |
25) Burr ML (2003) | No cohort name defined | 3,114 men from South Wales aged < 70, with angina, without other serious illness, and who did not eat oily fish twice a week. | (Randomized controlled trial) 3-9 | (1990-96 to 1999) See variables | Cardiac death | Experimental group (Fish advice: to eat ≥ 2 portions of oily fish each week, or to take up to 3 g of fish oil ['Maxepa']). | Control group (Advice to eat 'sensibly': non-specific advice that did not include intervention with oily fish/fish oil, vegetables, fruits, or oats).
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Drug interactions: Hazard ratios for cardiac death were calculated in relation to fish advice, with subjects classified into those receiving and those not receiving various types of drug at recruitment into the trial. No evidence was found of any adverse interactions; treatment with beta-blockers showed a significant favourable interaction with fish advice (no data shown). Age, smoking, previous MI, history of high blood pressure, diabetes, BMI, serum cholesterol, medication, and fruit advice. |
25) Burr ML (2003) | No cohort name defined | 3,114 men from South Wales aged < 70, with angina, without other serious illness, and who did not eat oily fish twice a week. | (Randomized controlled trial) 3-9 | (1990-96 to 1999) See variables | Cardiac death | Experimental group (Fish advice: to eat ≥ 2 portions of oily fish each week). | Control group (Advice to eat 'sensibly': non-specific advice that did not include intervention with oily fish/fish oil, vegetables, fruits, or oats).
|
Drug interactions: Hazard ratios for cardiac death were calculated in relation to fish advice, with subjects classified into those receiving and those not receiving various types of drug at recruitment into the trial. No evidence was found of any adverse interactions; treatment with beta-blockers showed a significant favourable interaction with fish advice (no data shown). Age, smoking, previous MI, history of high blood pressure, diabetes, BMI, serum cholesterol, medication, and fruit advice. |
24) Mozaffarian D (2005) | The Cardiovascular Health Study | 4,738 men and women aged ≥ 65, and free of congestive heart failure. | (US) 12 | (1989-90 to ) 955 | Congestive heart failure incidence | Tuna or other broiled or baked fish |
HR = 0.68 (0.45-1.03; P = 0.009) for the highest vs lowest quintile of consumption. | Amount specific data (Frequency of intake): < 1/mo: HR = 1. 1-3/mo: HR = 0.84 (0.67-1.06). 1-2/wk: HR = 0.80 (0.64-0.99). 3-4/wk: HR = 0.69 (0.52-0.91). ≥ 5/wk: HR = 0.68 (0.45-1.03). This association was attenuated after further adjustment for systolic blood pressure, diastolic blood pressure, baseline LV systolic funcation, LDL, HDL, triglycerides, and C-reactive protein: HR = 0.73 (0.48-1.09; P = 0.03).
Effect modification: There was little evidence that findings varied according to age, gender, education, income, diabetes, smoking, physical activity, prevalent cardiovascular disease, treated hypertension, or systolic blood pressure (p = > 0.05 for each interaction). Age, gender, race, enrollment site, education, diabetes, BMI, prevalent heart disease/stroke, total caloric intake, smoking, leisure-time physical activity, intakes of saturated fat, fruits, vegetables, alcohol, and fried fish. |
24) Mozaffarian D (2005) | The Cardiovascular Health Study | 4,738 men and women aged ≥ 65, and free of congestive heart failure. | (US) 12 | (1989-90 to ) 955? | Congestive heart failure incidence | Dietary EPA + DHA from fish meals, including shellfish | HR = 0.63 (0.57-0.94; P = 0.009) for the highest vs lowest quintile of consumption (> 487 vs < 92 mg/day, respectively). | Age, gender, race, enrollment site, education, diabetes, BMI, prevalent heart disease/stroke, total caloric intake, smoking, leisure-time physical activity, intakes of saturated fat, fruits, vegetables, and alcohol. |
24) Mozaffarian D (2003) | The Cardiovascular Health Study | 3,910 men and women aged ≥ 65 and free of known CVD. | 9.3 | See variables | Heart disease | Tuna/other fish ("tuna fish/tuna salad casserole" and other fish [broiled or baked]) |
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Effect modification: There was little evidence that associations varied according to age, gender, smoking, or presence of diabetes or obesity. (no data shown). Age, gender, education, diabetes, current smoking, pack-years of smoking, tuna/other fish and fried fish/fish sandwich consumption, BMI, systolic blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, C-reactive protein, and intake of saturated fat, alcohol, beef/pork, fruits, and vegetables. |
Further adjustments had little effect, including for recruitment community, race, income, diastolic blood pressure, heart rate, family history of MI, atrial fibrillation, selfperceived health, physical activity, exercise intensity, carotid intimal medial thickness; use of aspirin, beta-blockers, lipid-lowering medication, estrogen, and fish oil; fasting glucose and insulin, white blood cell count, fibrinogen, factor VII, and factor VIII; and estimated intake of total fat, polyunsaturated fat, carbohydrates, protein, wine, fried chicken or french fries, thiamine, vitamin A, and vitamin C. 24) Mozaffarian D (2003) | The Cardiovascular Health Study | 3,910 men and women aged ≥ 65 and free of known CVD. | 9.3 | See variables | Heart disease | Dietary n-3 PUFAs from fish meals |
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Age, gender, education, diabetes, current smoking, pack-years of smoking, tuna/other fish and fried fish/fish sandwich consumption, BMI, systolic blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, C-reactive protein, and intake of saturated fat, alcohol, beef/pork, fruits, and vegetables. |
23) Nagata C (2002) | The Takayama Study | 13,355 men and 15,724 women aged 35 or older. | (Japan) 7 | (1992-1999) 63 men, and | 52 women. Ischemic heart disease mortality | Fish oil |
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Age, total energy, marital status, BMI, smoking status, exercise, and history of hypertension. |
Additionally for men: alcohol intake, coffee intake, and history of diabetes mellitus. Additionally for women: age at menarche, and history of hysterectomy. Ischemic heart disease and cerebrovascular disease were adjusted for total energy and nondietary covariates. 22) Wennberg M (2011) | The Northern Sweden Health and Disease Study (NSHDS) | [Consisting of 3 subcohorts: -The Västerbotten Intervention Program (VIP). -The MONICA Study. -The Mammography Screening Project (MSP).] 73,000 subjects without myocardial infarction, stoke, or malignant disease. | (Nested case-control) 1987-99 to 1994-99 | 263 | Myocardial infarction (including sudden cardiac death) | Fish (e.g., lean fish [perch and cod]; fatty fish [e.g., herring, lavaret, and salmon]; and salty fish [salt herring]) |
OR = 1.21 (0.43-3.33; P = 0.52) for the highest vs lowest quartile of consumption. | Amount specific data (Meal frequency): < 1/mo: OR = 1. 1 mo-< 1/wk: OR = 0.88 (0.40-1.94). 1-2/wk: OR = 1.09 (0.55-2.15). > 2/wk: OR = 1.21 (0.43-3.33). Adjusted for Apo B/Apo A-I, smoking, systolic blood pressure, diabetes, education, consumption of fruits/vegetables, wine, strong beer, and physical activity. |
Controls were matched to cases for sex, age, date of health survey, type of health survey, and geographic region. 21) Whiteman D. (1999) | The OXCHECK Study. | 10,522 men and women aged 35-64 without a previous history of angina. | (UK) 9 | (1989-1997) 93 | IHD mortality | Fresh or frozen fish (not defined) |
RR = 1.36 (0.57-3.25; No P-value) for the highest vs lowest tertile of consumption. | Amount specific data (days/wk): < 1: RR = 1. 1-3: RR = 1.38 (0.90-2.12). 4-7: RR = 1.36 (0.57-3.25). Gender, smoking and age. |
20) Mann JI (1997) | The Oxford Vegetarian Study. | 10,802 subjects (4102 men and 6700 women) aged 16-79. | (UK) 13.3 | (1980-84 to 1995) 64 | Ischaemic heart disease death | Fish (not defined) |
Death rate ratio = 123 (70-217; P = Not Significant) for the highest vs lowest tertile of consumption. | Amount specific data (per week): Never eaten: DRR = 100. < once: DRR = 121 (62-238). ≥ once: DRR = 123 (70-217). Age, sex, smoking and social class. |
19) Yuan JM (2001) | The Shanghai Cohort Study | 18,244 men aged 45-64 from Shanghai (China), and without a history of cancer. | 12 | (1986-89 to 1998) See variables | Ischemic heart disease death | Seafood (fresh fish [e.g., carp, beam, pomfret]; salted fish [e.g., yellow croaker and hairtail]; and shellfish [e.g., shrimp and crab]) |
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One serving = 50 g. Age, total energy intake, level of education, BMI, current smoking, cigarettes smoked, alcohol, history of diabetes, and history of hypertension. |
Separate inclusion of intake levels of red meats; poultry; vegetables; fruit; soybeans and soy products; legumes; carbohydrate; protein; total fat; saturated, monounsaturated, and polyunsaturated fats other than n-3 fatty acids; and cholesterol did not materially alter the association with fatal MI. 19) Yuan JM (2001) | The Shanghai Cohort Study | 18,244 men aged 45-64 from Shanghai (China), and without a history of cancer. | 12 | (1986-89 to 1998) See variables | Ischemic heart disease death | Fresh and salted fish (fresh fish [e.g., carp, beam, pomfret]; salted fish [e.g., yellow croaker and hairtail]) |
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Age, total energy intake, level of education, BMI, current smoking, cigarettes smoked, alcohol, history of diabetes, and history of hypertension. |
Separate inclusion of intake levels of red meats; poultry; vegetables; fruit; soybeans and soy products; legumes; carbohydrate; protein; total fat; saturated, monounsaturated, and polyunsaturated fats other than n-3 fatty acids; and cholesterol did not materially alter the association with fatal MI. 19) Yuan JM (2001) | The Shanghai Cohort Study | 18,244 men aged 45-64 from Shanghai (China), and without a history of cancer. | 12 | (1986-89 to 1998) See variables | Ischemic heart disease death | N-3 fatty acids from seafood |
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Age, total energy intake, level of education, BMI, current smoking, cigarettes smoked, alcohol, history of diabetes, and history of hypertension. |
Separate inclusion of intake levels of red meats; poultry; vegetables; fruit; soybeans and soy products; legumes; carbohydrate; protein; total fat; saturated, monounsaturated, and polyunsaturated fats other than n-3 fatty acids; and cholesterol did not materially alter the association with fatal MI. 18) Pietinen P (1997) | The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study | 21,930 male smokers (≥ 5 cigarettes/day) aged 50-69, and free of CVD, diabetes or cancer. | (Finland) 6.1 | (1985-88 to 1993) 635? | Coronary heart disease death | Fish (not defined) | RR = 1.12 (0.87-1.45; P = 0.09) for the highest vs lowest quintile (not defined). | Age, treatment group, smoking, BMI, blood pressure, intakes of energy, alcohol, and fiber, education, and physical activity. |
17) Gillum RF (2000) | The NHANES I Study | 8,825 white and black men and women aged 24-74. | (USA) 18.8 | (1971-75 to 1992) CHD risk: 2,007. | CHD death: 752. Coronary heart disease incidence | Fish or shellfish (not defined) |
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CHD death: No consistent significant association was found (no data shown). Effect modification: The interaction of age and fish consumption was not significant for any group. Age, smoking, history of diabetes, education, high school graduate, systolic blood pressure, serum cholesterol concentration, BMI, alcohol intake, and physical activity. |
17) Gartside PS (1998) | The NHANES I | 5,811 men and women aged 40-74 with and without CHD and not using any special diets. | 16 | (1971-1987) 1,958 | CHD risk (morbidity and mortality) | Fish (not defined) |
OR = 0.10 (P = 0.048) |
Effect modification: No significant interactions were found with Age, race, gender, geographic region, physical exercise, physical activity, education, smoking, BMI, alcohol, fish, bread, cheese, and dessert intake. Age, race, gender, geographic region, serum cholesterol, physical exercise, physical activity, education, smoking, BMI, alcohol, bread, cheese, and dessert intake. |
16) Soinio M (2003) | No cohort name defined. | 366 men and 295 women with diabetes type 2, but free from CHD, aged 45-64 from Kuopio. | (Finland) 7 | (1982-84 to 1989) CHD: 74 men and 43 women. | CHD death: 41 men and 24 women. CHD (nonfatal MI or CHD death) | Fish (not defined) | No significant association was found with CHD death or total CHD events (no data shown). | Age and diabetes duration. |
16) Salonen JT (1995) | The KIHD Study | 1,833 men aged 42-60. | (Finland) 1984-89 to 1991 | Fatal or nonfatal AMI: 73? | CHD death: 18? CHD | Fish (not defined) |
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The most commonly used fish species were vendance (Coregonus albula, a small local white fish) (17%), rainbow trout (12%), and the Northern pike (10%). Age, examination year, ischemic exercise, ECG, maximal oxygen uptake, family history of CHD, cigarette-years, mean systolic blood pressure, diabetes, socioeconomic status, place of residence, dietary iron intake, and serum apolipoprotein B, HDL-cholesterol, and ferritin concentrations. |
Additional adjustment for intakes of energy, saturated fatty acids, dietary polyunsaturated fatty acids, and carotene; the consumption of alcohol and coffee; leisure time physical activity; BMIK; blood leukocyte count; plasma ascorbate and alpha-tocopherol, serum copper, albumin, and triglyceride concentrations had no appreciable effect on the RRs. 15) Albert CM (1998) | The Physician's Health Study | 20,551 men aged 40-84, and without a history of MI, stroke, transient ischemic attack, or cancer. | (USA) 11 | (1983-1995) See variables | Coronary heart disease | Fish or shellfish (canned tuna fish; dark meat fish [eg, mackerel, salmon, sardines, bluefish, or swordfish]; other fish; and shrimp, lobster, or scallops as a main dish) |
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Age, aspirin and beta carotene treatment assignment, evidence of CVD, BMI, smoking status, history of diabetes, history of hypertension, history of hypercholesterolemia, alcohol, vigorous exercise, vitamine E, vitamin C, and multivitamin use. |
15) Albert CM (1998) | The Physician's Health Study | 20,551 men aged 40-84, and without a history of MI, stroke, transient ischemic attack, or cancer. | (USA) 11 | (1983-1995) 133 | Sudden death | Dietary marine N-3 fatty acids (from fish or shellfish: canned tuna fish; dark meat fish [eg, mackerel, salmon, sardines, bluefish, or swordfish]; other fish; and shrimp, lobster, or scallops as a main dish) |
RR = 0.43 (0.20-0.93; P = 0.21) for the highest vs lowest quintile of consumption. | Amount specific data (g/mo): < 0.3: RR = 1. 0.3-< 2.7: RR = 0.58 (0.28-1.21). 2.7-< 4.9: RR = 0.34 (0.15-0.74). 4.9-< 7.4: RR = 0.60 (0.29-1.27). ≥ 7.4: RR = 0.43 (0.20-0.93). Age, aspirin and beta carotene treatment assignment, evidence of CVD, BMI, smoking status, history of diabetes, history of hypertension, history of hypercholesterolemia, alcohol, vigorous exercise, vitamine E, vitamin C, and multivitamin use. |
15) Morris MC (1995) | The Physician's Health Study | 21,185 men aged 40-84, and without a history of MI, stroke, transient ischemic attacks, cancer, liver/renal disease, peptic ulcer, gout, current use of aspirin, other platelet-active drugs, or NSAID's. | (USA) 4 | (1983-1988) See variables | Myocardial infarction (excluding silent infarctions) | Fish (canned tuna fish; dark meat fish [e.g., mackerel, salmon, sardines, bluefish, swordfish]; other fish. | Excluding shrimp, lobster, or scallops as a main dish)
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Canned tuna fish; dark meat fish [4-6 oz/113-170 g]; other fish [4-6 oz/113-170 g]. Age, aspirin and beta-carotene assignment, smoking, alcohol consumption, obesity, diabetes mellitus, vigorous exercise, parental history of MI, history of hypertension, history of hypercholesterolemia, vitamin supplement use, and saturated fat intake. |
Stratified analysis are adjusted for age and randomized assignment to aspirin and beta-carotene, only. 15) Morris MC (1995) | The Physician's Health Study | 21,185 men aged 40-84, and without a history of MI, stroke, transient ischemic attacks, cancer, liver/renal disease, peptic ulcer, gout, current use of aspirin, other platelet-active drugs, or NSAID's. | (USA) 4 | (1983-1988) See variables | Myocardial infarction (excluding silent infarctions) | Long-chain omega 3 fatty acids from seafood (EPA & DHA from canned tuna fish; dark meat fish [e.g., mackerel, salmon, sardines, bluefish, swordfish]; other fish; and shrimp, lobster, or scallops as a main dish. | Excluding alpha-linolenic acid, and fish oil supplements)
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Age, aspirin and beta-carotene assignment, smoking, alcohol consumption, obesity, diabetes mellitus, vigorous exercise, parental history of MI, history of hypertension, history of hypercholesterolemia, vitamin supplement use, and saturated fat intake. |
14) Bernstein AM (2010) | The Nurses' Health Study | 84,136 women aged 34-59, and without cancer, diabetes mellitus, angina, myocardial infarction, stroke, or other cardiovascular disease (including coronary artery bypass grafting) | 26 | (1980-2006) 3,162? | Coronary heart disease (nonfatal infarction and CHD death) | Fish (canned tuna, dark- and light-fleshed fish, and breaded fish) |
RR = 0.81 (0.72-0.90; P = < 0.001) for the highest vs lowest quintile of consumption. | Amount specific data (servings per day): 0.07: RR = 1. 0.11: RR = 0.76 (0.65-0.87). 0.14: RR = 0.94 (0.85-1.03). 0.25: RR = 0.76 (0.68-0.86). 0.43: RR = 0.81 (0.72-0.90). Further adjustment for fruit and vegetable intake had no effect on the risk associations. Age, time period, total energy, cereal fiber, alcohol, trans fat, BMI, cigarette smoking, menopausal status, parental history of myocardial infarction, multivitamin use, vitamin E supplement use, aspirin use, and physical exercise. |
14) Sun Q (2008) | The Nurses' Health Study | 32,826 participants who provided blood samples in 1989-90 and were free of cancer or CVD. | (Nested case-control) 6 | (1990-?) 146? | Nonfatal MI | Fish (canned tuna fish, dark-meat fish, other fish, and shellfish) | No significant difference in fish intake was found between cases (1.5 servings/wk) and controls (1.5 servings/wk; P = 0.77). | Matched for age, smoking status, and fasting status. |
Unadjusted. 14) Mozaffarian D (2005) | The Health Professionals Follow-up Study | 45,722 men aged 40-75, and free of CVD. | (USA) 14 | (1986-2000) See variables | CHD incidence (sudden death, other CHD death, and nonfatal MI) | Dietary EPA + DHA from seafood (not defined, but excluding supplements) |
Sudden death (218? cases): | HR = 0.65 (0.47-0.88) for ≥ 250 vs < 250 mg/day.
Age, BMI, smoking, physical activity, history of diabetes, hypertension, or hypercholesterolemia, aspirin use, alcohol use, intake of protein, saturated fat, dietary fiber, monounsaturated fat, trans fatty acids, total calories, and ALA. |
14) Hu FB (2003) | The Nurses' Health Study | Women without type 2 diabetes mellitus. | 1980-96 | 1,257 | CHD incidence | Fish (dark-meat fish [such as mackerel, salmon, sardines, bluefish, or swordfish]; canned tuna; other fish; and shrimp, lobster, or scallops as main dish) |
RR = 0.78 (P = 0.028) for the highest vs lowest quintile of consumption. | Amount specific data (Frequency of intake): < 1/mo: RR = 1. 1-3/mo: RR = 0.88 1/wk: RR = 0.80 2-4/wk: RR = 0.75 5+/wk: RR = 0.78. Frequency of consumption was defined in portion units of 6-8 oz. Age, time intervals, smoking status, BMI, alcohol intake, parental history of MI, menopausal status and postmenopausal hormone use, moderate to vigorous activities, usual aspirin use, multivitamin supplement use, vitamin E supplement use, history of hypertension, hypercholesterolemia, duration of diabetes, hypoglycemic medication. And possibly also for trans fat, the ratio of polyunsaturated:saturated fat, and dietary fiber. |
14) Hu FB (2003) | The Nurses' Health Study | 5,103 women with physician-diagnosed type 2 diabetes mellitus. | 1980-96 | 362 | CHD incidence | Fish (dark-meat fish [such as mackerel, salmon, sardines, bluefish, or swordfish]; canned tuna; other fish; and shrimp, lobster, or scallops as main dish) |
RR = 0.38 (0.21-0.68; P = 0.002) for the highest vs lowest quintile of consumption. | Amount specific data (Frequency of intake): < 1/mo: RR = 1. 1-3/mo: RR = 0.70 (0.48-1.02). 1/wk: RR = 0.60 (0.42-0.85). 2-4/wk: RR = 0.65 (0.43-0.99). 5+/wk: RR = 0.38 (0.21-0.68). Additional adjustment for trans fat, the ratio of polyunsaturated:saturated fat, and dietary fiber did not change the association: RR = 0.36 (0.20-0.66; P = 0.002).
Frequency of consumption was defined in portion units of 6-8 oz. Age, time intervals, smoking status, BMI, alcohol intake, parental history of MI, menopausal status and postmenopausal hormone use, moderate to vigorous activities, usual aspirin use, multivitamin supplement use, vitamin E supplement use, history of hypertension, hypercholesterolemia, duration of diabetes, and hypoglycemic medication. |
Additional adjustment for fruits, vegetables, and red meat did not materially affect the RRs. 14) Hu FB (2003) | The Nurses' Health Study | 5,103 women with physician-diagnosed type 2 diabetes mellitus. | 1980-96 | 362 | CHD incidence | Long-chain omega-3 fatty acids (EPA & DHA from dark meat fish [canned tuna, other fish, and shrimp, lobster or scallops], chicken and liver) |
RR = 0.69 (0.47-1.03; P = 0.10) for the highest vs lowest quintile of consumption. | Amount specific data (g/d): 0.04: RR = 1. 0.06: RR = 0.96 (0.71-1.31). 0.09: RR = 0.85 (0.60-1.20). 0.15: RR = 0.92 (0.66-1.30). 0.25: RR = 0.69 (0.47-1.03).
Age, time intervals, smoking status, BMI, alcohol intake, parental history of MI, menopausal status and postmenopausal hormone use, moderate to vigorous activities, usual aspirin use, multivitamin supplement use, vitamin E supplement use, history of hypertension, hypercholesterolemia, duration of diabetes, hypoglycemic medication, trans fat, the ratio of polyunsaturated:saturated fat, and dietary fiber. |
14) Hu FB (2002) | The Nurses' Health Study | 84,688 women aged 34-59, and free of CVD and cancer. | 16 | (1980-1996) See variables | CHD incidence (CHD death and nonfatal myocardial infarctions) | Fish ((1) dark-meat fish such as mackerel, salmon, sardines, bluefish, or swordfish (84-140 g [3-5 oz]); (2) canned tuna (84-112 g [3-4 oz]); (3) other fish (84-140 g [3-5 oz]); and (4) shrimp, lobster, or scallops as the main dish (98 g [3.5 oz])) |
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Age, time periods, smoking status, BMI, alcohol intake, menopausal status, vigorous to moderate activity, aspirin, multivitamin use, vitamin E supplement use, and history of hypertension, hypercholesterolemia, and diabetes. |
Further adjustment for intake of fruits and vegetables, red meat, or alpha-linolenic acid did not appreciably alter the results. 14) Stampfer MJ (2000) | The Nurses' Health Study | 84,129 women who were free of CVD, cancer, and diabetes. | (USA) 14 | (1980-1994) 1,128? | Major coronary events (nonfatal myocardial infarction or coronary heart disease death) | Marine n-3 fatty acids (not defined) | A significant protective effect was found for the highest vs lowest quintile of consumption (> 0.1% of energy from marine n-3 fatty acids; no data shown). | Age, time periods, parental history of MI before age 60, menopausal status, use of postmenopausal hormones, history of hypertension, and history of high cholesterol levels. |
14) Ascherio A (1995) | The Health Professionals Follow-up Study | 44,895 male health professionals aged 40-75, and free of CVD. | 6 | (1986-1992) 1,543 | CHD (fatal coronary disease, nonfatal myocardial infarction, and coronary-artery bypass grafting or angioplasty) | Fish (dark meat fish [e.g., bluefish], canned tuna, other fish, and shrimp, lobster, or scallops) |
RR = 1.14 (0.86-1.51; P = 0.19) for the highest vs lowest sextile of consumption. | Amount specific data (servings & g/day): < 1/mo (0 g/d): RR = 1. 1-3/mo (7 g/d): RR = 0.87 (0.64-1.18). 1/wk (18 g/d): RR = 1.02 (0.79-1.31). 2-3/wk (37 g/d): RR = 0.92 (0.71-1.18). 4-5/wk (69 g/d): RR = 0.99 (0.76-1.30). ≥ 6/wk (119 g/d): RR = 1.14 (0.86-1.51). No association was found among men with low linolenic acid.
Age, BMI, smoking habits, alcohol consumption, history of hypertension, history of diabetes, history of hypercholesterolemia, family history of MI, and profession. |
14) Ascherio A (1995) | The Health Professionals Follow-up Study | 44,895 male health professionals aged 40-75, and free of CVD. | 6 | (1986-1992) 264 | Fatal CHD (including sudden death) | Fish (dark meat fish [e.g., bluefish], canned tuna, other fish, and shrimp, lobster, or scallops) |
RR = 0.77 (0.41-1.44; P = 0.14) for the highest vs lowest sextile of consumption. | Amount specific data (servings & g/day): < 1/mo (0 g/d): RR = 1. 1-3/mo (7 g/d): RR = 0.74 (0.38-1.45). 1/wk (18 g/d): RR = 0.86 (0.50-1.47). 2-3/wk (37 g/d): RR = 0.71 (0.41-1.21). 4-5/wk (69 g/d): RR = 0.54 (0.29-1.00). ≥ 6/wk (119 g/d): RR = 0.77 (0.41-1.44). Age, BMI, smoking habits, alcohol consumption, history of hypertension, history of diabetes, history of hypercholesterolemia, family history of MI, and profession. |
14) Ascherio A (1995) | The Health Professionals Follow-up Study | 44,895 male health professionals aged 40-75, and free of CVD. | 6 | (1986-1992) 1,543 | CHD (fatal coronary disease, nonfatal myocardial infarction, and coronary-artery bypass grafting or angioplasty) | N-3 fatty acids from fish (dark meat fish [1.37 g/portion]; canned tuna [0.69 g]; other fish [0.17 g]; and shrimp, lobster, or scallops [0.46 g]) |
RR = 1.12 (0.96-1.31; P = 0.09) for the highest vs lowest quintile of consumption. | Amount specific data (g/day): 0.01-0.11: RR = 1. 0.12-0.19: RR = 0.98 (0.83-1.15). 0.20-0.28: RR = 0.97 (0.83-1.15). 0.29-0.41: RR = 0.99 (0.84-1.17). 0.42-6.52: RR = 1.12 (0.96-1.31). Additional adjustment for physical activity and intake of vitamin E and carotene strengthened the association: RR = 1.22 (1.03-1.44). No association was found among men with low linolenic acid.
Age, energy, BMI, smoking habits, alcohol consumption, history of hypertension, history of diabetes, history of hypercholesterolemia, family history of MI, and profession. |
14) Ascherio A (1995) | The Health Professionals Follow-up Study | 44,895 male health professionals aged 40-75, and free of CVD. | 6 | (1986-1992) 264 | Fatal CHD (including sudden death) | N-3 fatty acids from fish (dark meat fish [1.37 g/portion]; canned tuna [0.69 g]; other fish [0.17 g]; and shrimp, lobster, or scallops [0.46 g]) |
RR = 1.03 (0.70-1.52; P = 0.94) for the highest vs lowest quintile of consumption. | Amount specific data (g/day): 0.01-0.11: RR = 1. 0.12-0.19: RR = 1.14 (0.78-1.66). 0.20-0.28: RR = 0.95 (0.64-1.41). 0.29-0.41: RR = 1.03 (0.70-1.52). 0.42-6.52: RR = 1.03 (0.70-1.52). Sudden death (death within one hour of the onset of symptoms. 89 cases): Age-adjusted RR = 1.10 (0.56-2.13). Age, energy, BMI, smoking habits, alcohol consumption, history of hypertension, history of diabetes, history of hypercholesterolemia, family history of MI, and profession. |
13) Järvinen R (2006) | The Finnish Mobile Clinic Health Survey | 2,775 men, and 2,445 women aged 30-79, and free of CHD. | 21.5 | (1967-72 to 1992) See variables | CHD death | Total fish (not defined) |
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Age, energy intake, area, BMI, serum cholesterol, blood pressure, smoking, occupation and diabetes. |
13) Järvinen R (2006) | The Finnish Mobile Clinic Health Survey | 2,775 men, and 2,445 women aged 30-79, and free of CHD. | 21.5 | (1967-72 to 1992) See variables | CHD death | Long-chain n-3 fatty acids (fish specific EPA and DHA) |
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Age, energy intake, area, BMI, serum cholesterol, blood pressure, smoking, occupation and diabetes. |
13) Knekt P (1994) | The Finnish Mobile Clinic Health Cohort | 5,133 men and women aged 30-69, and free of heart disease. | 14 | (1968-72 to 1984) 186? men, and 58? women. | CHD mortality | Fish (not defined) |
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Age. |
12) Kromhout D (1995) | Cohort name not defined | 272 subjects (137 men and 135 women) aged 64-87 from a general practice in Rotterdam. | (The Netherlands) 17 | (1971-1987) 58 | Primary & secondary CHD mortality | Fish (mostly lean fish [e.g., cod and plaice], but also minimal amounts of fatty fish [e.g., herring and mackerel], and canned fish [e.g., sardines]) | RR = 0.51 (0.29-0.89) for fish intake vs no fish intake. | Stratified analysis: For men, the RR was 0.41 (0.20-0.86), and for women it was 0.64 (0.25-1.63). Age, gender, prevalence of myocardial infarction and angina pectoris, systolic blood pressure, total cholesterol, smoking, alcohol and energy intake/bodyweight. |
12) Feskens EJ (1993) | No cohort name defined | 272 men and women aged 64-87 from Rotterdam | (The Netherlands) 17 | (1971 to 1987) See variables | CHD mortality | Fish (90% consisted of lean fish, such as cod and plaice) |
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The difference in effect between men and women was small, and this was also noticed with respect to differences in sBP and smoking. Age, sex, BMI, smoking, alcohol use, serum lipids, BP, and CHD prevalence, and intake of energy, polyunsaturated fat, and carbohydrates. |
11) Dolecek TA (1992) | The Multiple Risk Factor Intervention Trial (MRFIT) | 6,250 men aged 35-57, and at a high risk of CHD. | (USA) 10.5 | (?-1985) 175? | Coronary heart disease mortality | Dietary n-3 fish fatty acids | This was a randomized trial, but only data from the "usual care" group was analyzed. |
Age, race, smoking, baseline diastolic blood pressure, HDL, LDL, and alcohol. |
11) Dolecek TA (1991) | The Multiple Risk Factor Intervention Trial (MRFIT) | 6,258 men aged 35-57, and at a high risk of developing CHD based upon smoking status, diastolic blood pressure, and serum cholesterol levels. | (USA) ?-1985 | 175 | CHD mortality | Dietary long-chain omega 3 fatty acids from fish [EPA (20:5), DPA (22:5), and DHA (22:6)] | This was a randomized trial, but only data from the "usual care" group was analyzed. | RR = 0.60 (No 95% CI; P = 0.02) for the highest vs lowest quintile of consumption. Amount specific data (g): 0.000: RR = 1 0.009: RR = 1.08 0.046: RR = 0.91 0.153: RR = 0.88 0.664: RR = 0.60 Age, race, baseline smoking, diastolic blood pressure, HDL and LDL levels. |
10) Kinjo Y (1999) | No cohort name defined | 223,170 men and women aged 40-69, and without a history of diseases other than stomach disease. | (Japan) 1966-1981 | ? | Ischaemic heart disease mortality | Fish (not defined) | No association with ischaemic heart disease was found (results not shown). | Sex, attained age, follow-up interval, prefecture, alcohol drinking, smoking and occupation. |
10) Hirayama T (1990) | No cohort name defined | 265,118 adults (122,261 men, 142,857 women) aged ≥ 40 from 6 prefectures in Japan. | 17 | (1966-1982)
Ischaemic heart disease mortality: (2,170? men, and 1,378? women). | Other heart disease mortality: (Number of cases not clearly defined). Hypertensive heart disease mortality: (559? men, and 613? women). Rheumatic heart disease mortality: (131 men?, and 233? women). Heart disease mortality | Fish & shellfish (not defined) |
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Not defined (possibly only age). |
Age and sex-adjusted for the associations with men & women combined. 9) Ness AR (2002) | The Diet and Reinfarction Trial (DART) | 2,033 men aged < 70 who had survived a MI, and were rectruited from hospitals in England. | (Randomized trial) 1983-87 to 2000 | 738 | CHD mortality | Experimental group: (Men were encouraged to eat 2 portions of fatty fish a week and as much other fish as they could manage. Those unable to eat this amount of fish were offered fish oil capsules [MaxEPA]). | Control group: (No fish advice)
Dietary differences: | -At 2 y reported fatty fish intake was 35 g per day in the fish advice group and around 9 g per day in those not given fish advice. -At the end of the follow-up period in 1999-2000 those allocated to fish advice reported eating more fish (43.6 vs 36.9 g/day; P = < 0.01) and in particular more fatty fish (20.7 vs 13.2 g/day; P = < 0.01) although the differences were substantially reduced compared to those reported at 2 y. In addition, they were more likely to take fish oil supplements (120 [26.9%] vs 83 [19.3%; P = < 0.01]). Results: HR = 0.91 (0.79-1.05). Hazard by follow-up period in years: 0-2: HR = 0.65 (0.49-0.87). 2-5: HR = 1.08 (0.79-1.47). 5-10: HR = 1.03 (0.78-1.35). 10+: HR = 0.96 (0.71-1.29). Unadjusted. |
Adjustment for history of MI, angina, hypertension at baseline; X-ray evidence of cardiomegaly, pulmonary congestion or pulmonary oedema at baseline; and treatment (at entry) with b-blockers, other anti-hypertensives, digoxin/anti-arrhythmics, or anticoagulants did not change the HRs. 9) Burr ML (1989) | The Diet And Reinfarction Trial (DART) | 2,033 men aged < 70, admitted to 21 hospitals, and who had recovered from acute MI (excluding diabetic patients). | (Randomised controlled trial). 2 | See variables | CHD | Experimental group: fish advice (≥ 2 weekly portions [200-400 g] of fatty fish [mackerel, herring, kipper, pilchard, sardine, salmon, or trout]). | Control group: No fish advice.
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-Men were allocated to receive or not to receive advice on each of 3 dietary factors: (1) fat advice, (2) fish advice, and (3) fibre advice, thus creating 8 possible combinations. -At 6 months and 2 years, the subjects was administered a detailed dietary questionnaire. -In the fish advice group 14% took maxepa capsules at 6 months, and 22% at 2 years as a partial substitute for fatty fish. -The amount of fish in the study was small, supplying 2.5 g EPA weekly (corresponding to about 300 g fatty fish every week), and thus involved no radical change in diet. -During the first 6 months a small but significant (p = < 0.01) net increase of 2.1% in total cholesterol was attributable to fish advice; however, over the 2 years, the net change attributable to fish advice was not significant. -On average the weights of the subjects did not change much during the trial: the overall mean weight rose by 0-6 kg. Unadjusted. |
8) Fraser GE (1997) | The Adventist Health Study | Non-Hispanic white Seventh Seventh Day Adventists aged ≥ 84. | At study baseline there were 603 subjects older than 84 years, and during a 12-year follow-up, these and intitially younger subjects contributed 11,828 person-years of observation in the oldest-old age range. (USA) 12 | (1976-88) 364? | (110 men, and 254 women) CHD death | Fish (not defined) |
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Sex, diabetes, smoking, exercise, nuts, fruit, bread, donuts, sweet desserts, and beef. |
8) Fraser GE (1994) | The Adventist Health Study | 26,473 nondiabetic California Seventh-day Adventists. | No data shown. | No data shown. | Coronary events incidence (nonfatal myocardial infarction or definite fatal coronary heart disease) | Fish (not defined) |
none: Relative Hazard = 1.00. | < 1/wk: Relative Hazard = 0.91. > or = 1/wk: Relative Hazard = 0.97 (No 95% CI; No P-value). Proportional hazards analysis. |
8) Fraser GE (1992) | The Adventist Health Study | 31,208 non-Hispanic white California Seventh-Day Adventists. | (USA) 6 | (1977-1982) Definite nonfatal myocardial infarction: 134? | Definite fatal CHD: 260? Incident coronary death (by death certificate): 463? CHD | Fish (not defined) |
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Age, sex, smoking, exercise, relative weight, and high blood pressure. |
8) Fraser GE (1988) | The Adventist Health Study. | 28,038 nondiabetics who reported no previous history of MI. | 1977-1982 | 200? | definite MI risk | Fish (not defined) | No significant association (no data shown). | Multivariate analyses. |
7) Tanaka H (1987) | The Shibata Study | 963 men + 1,338 women aged ≥ 40, and without ischemic heart disease. | (Japan) 7.5 | (1977-1984) Not defined. | Ischemic heart disease risk | (MI + angina pectoris + sudden death) Fish (not defined) | No significant association was observed: RR = 1.23 (No 95% CI; No P-value) for intake ≥ 2.64 g/kg body weight per day. | Sex and age. |
6) Lapidus L (1986) | Cohort name not defined. | 1,462 women in Gothenburg. | (Sweden) 12 | (1968-69 to 1980-81) 23? | Risk of MI | Fish (not defined) | No significant correlation was found (no data shown) | Age. |
5) Norell SE (1986) | The cohort of Swedish Twins | 10,966 subjects without previous cardiovascular symptoms. | 14 | (1969-1982) CHD: 800. | MI: 385. Coronary heart disease death | Fish (not defined) |
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Sex specific relative risks showed a similar pattern for men and women. Age and sex. |
Further adjustment for smoking habits, relative weight, marital state, geographical region, degree of urbanisation, and a history of hypertension had little or no effect on the RRs. 4) Rodriguez BL (1996) | The Honolulu Heart Program | 7,513 (3,310 currently smoking) Japanese-American men aged 45-68, and without CHD, stroke, and cancer from Oahu | (Hawaii) 23 | (1965-68 to ?) Not defined | Coronary heart disease | Fish (not defined) |
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Age, years in Japan, total calories, physical activity, years smoked, hypertension, and serum cholesterol, glucose, and uric acid levels. |
4) Curb JD (1985) | The Honolulu Heart Program | 7,615 Japanese men without prevalent atherosclerotic disease. | 12 | Not defined | CHD incidence | Fish (not defined) |
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* = only 10 men consumed fish > 1 time/day. Age. |
3) Vollset SE (1985) | No cohort name defined | 11,000 men. | (Norway) 14 | (1968-1981) All subjects: 967. | Subjects without a history of CHD: 301. Death from CHD | Fish (not defined) |
All men: | Numbers of Observed and Expected deaths for increasing sextiles of consumption (P = 0.93). Amount specific data (Frequency of consumption per month): 0-4: Observed deaths = 49. Expected deaths = 55.4 5-9: Observed deaths = 217. Expected deaths = 199.7 10-14: Observed deaths = 379. Expected deaths = 392.6 15-19: Observed deaths = 145. Expected deaths = 149.8 20-24: Observed deaths = 139. Expected deaths = 128.9 ≥ 25: Observed deaths = 38. Expected deaths = 40.7 Men without a history of CHD (prolonged chest pain or angina pectoris). Death from acute MI only: Numbers of Observed and Expected deaths for increasing sextiles of consumption (P = 0.14). Amount specific data (Frequency of consumption per month): 0-4: Observed deaths = 17. Expected deaths = 18.2 5-9: Observed deaths = 62. Expected deaths = 65.3 10-14: Observed deaths = 123. Expected deaths = 123.6 15-19: Observed deaths = 41. Expected deaths = 47.4 20-24: Observed deaths = 42. Expected deaths = 34.8 ≥ 25: Observed deaths = 16. Expected deaths = 11.6 The results were homogenous over age groups except for men under 46 years (22 deaths). In this group a negative trend was noted (P = 0.058), which remained after exclusion of persons with cardiovascular symptoms. Stratified by age, urban/rural status, region, and smoking status. |
2) Daviglus ML (1997) | The Chicago Western Electric Study | 1,822 men aged 40-55, and free of cardiovascular disease. | 30 | (1957-59 to ?) 430 | CHD death | Fish (not defined) |
RR = 0.62 (0.40-0.94; P = 0.040) for the highest vs lowest quartile of consumption. | Amount specific data (g/day): 0: RR = 1. 1-17: RR = 0.88 (0.63-1.22). 18-34: RR = 0.84 (0.61-1.17). ≥ 35: RR = 0.62 (0.40-0.94).
Age, education, religion, systolic pressure, serum cholesterol, number of cigarettes smoked, BMI, diabetes, electrocardiographig abnormalities, and intake of energy, cholesterol, saturated, monounsaturated, and polyunsaturated fatty acids, total protein, cabohydrate, alcohol, iron, thiamine, riboflavin, niacin, vitamin C, beta carotene, and retinol. |
2) Shekelle RB (1985) | The Western Electric Study | 1,931 middle-aged men. | (Chicago) 25 | (1957-?) 325 | Coronary heart disease death | Fish (not defined) |
A significant inverse association was found for the highest vs lowest quartile of consumption (P = 0.008). | Amount specific data (g/day): 0: % of deaths = 20.5 1-17: % of deaths = 18.7 18-34: % of deaths = 15.5 > 35: % of deaths = 13.0. This association remained after adjustment for age, blood pressure, serum cholesterol, cigarette smoking, BMI, evidence of existing disease (e.g., diabetes mellitus, hypertensive retinopathy, or electrocardiographic abnormalities), intake of dietary cholesterol, % of calories from saturated, monounsaturated fatty acids, and polyunsaturated fatty acids, education, intake of energy/kg weight, and alcohol (P = 0.004). Unadjusted. |
1) Streppel MT (2008) | The Zutphen Study | (The Dutch contribution to The Seven Countries Study) 1,373 men | 40 | (1960-85 to 2000) See variables | CHD death | Total fish (fatty fish [e.g. salmon, mackerel, herring, eel, and sardines], and lean [e.g. codfish, plaice, and pollack fish]) |
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Energy, alcohol intake, wine use, fruit and vegetable consumption, saturated fat, trans unsaturated fatty acids, cis monounsaturated and polyunsaturated fat intake, serum cholesterol lowering diet, smoking BMI, prevalence of diabetes mellitus, systolic blood presurre, and socioeconomic status. |
1) Oomen CM (2000) | The Seven Countries Study | 1,088 Finnish, 1,097 Italian, and 553 Dutch men aged 50-69, and free of CHD. | 20 | (1965-70 to ) 463 | CHD mortality (as primary or secondary cause of death) | Fish (lean [e.g., plaice codfish, bream, perch, pike], fatty [e.g., mackerel, (salted) herring, eel], and canned [e.g., sardines, salmon]) |
RR = 1.08 (0.76-1.53) for the highest vs lowest quartile of consumption. | Amount specific data (g/day): 0: RR = 1. 1-19: RR = 0.93 (0.69-1.31). 20-39: RR = 0.95 (0.69-1.31). ≥ 40: RR = 1.08 (0.76-1.53).
Age, BMI, cigarette smoking, and intakes of energy, vegetables, fruit, alcohol, meat, butter, and margarine. |
1) Kromhout D (1985) | The Zutphen Study | (The Dutch contribution to The Seven Countries Study) 852 men aged 40-59 without CHD. | 20 | (1960-1980) 78 | Death from coronary heart disease | Fish (2 thirds consisted of lean fish [e.g., cod and plaice], and 1 third consisted of fat fish [e.g., herring and mackerel]) |
RR = 0.39 (0.13-1.15; P = < 0.05) for the highest vs lowest quintile of consumption. | Amount specific data (g/day): 0: RR = 1. 1-14: RR = 0.64 (0.32-1.26). 15-29: RR = 0.56 (0.27-1.15). 30-44: RR = 0.36 (0.14-0.93). ≥ 45: RR = 0.39 (0.13-1.15). Age, systolic blood pressure, serum total cholesterol, cigarette smoking, subscapular skinfold thickness, physical activity, energy intake, dietary cholesterol, prescribed diet, and occupation. |
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