HealthLINK: Cardiac: Fish with omega-3 fatty acids: good fuel for your heart

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July 2, 2002

News this month
Fish with omega-3 fatty acids: good fuel for your heart

Nutritionists have been promoting the health benefits of adding fish to your diet for many years, and now three separate studies published in major medical journals have uncovered additional evidence that fatty acids found in high amounts in certain kinds of fish are good for your heart.

Consumption of fish cut women's risk of dying from heart disease by 20-45%.

Benefits for women
A report in JAMA, the Journal of the American Medical Association, looked at the impact of omega-3 fatty acids on heart disease in women. Dr. Fran Hu of the Harvard School of Public Health and his colleagues reviewed data on 84,688 female nurses, ages 34 to 59, who participated in the large Nurses' Health Study over 16 years. They found that:

High consumption of fish (five times a week) cut the risk of dying from heart disease by 45 percent compared to women who rarely ate fish
Eating fish two to four times a week lowered the risk of suffering a heart attack by 31 percent
Even low fish consumption (one to three times a month) cut the risk of developing heart disease by more than 20 percent.

Reduced sudden death in men
A study published in The New England Journal of Medicine concluded that omega-3 fatty acids reduce the risk of sudden death in apparently healthy men who have no signs of cardiovascular disease. The study compared 94 men who died suddenly to 181 other men. Men with the highest levels of omega-3 fatty acids had an 81 percent lower risk of dying suddenly than men with the lowest levels, according to the study.

High levels of omega-3 fatty acids cut men's risk of dying suddenly by 81%.

“It's a low-risk, very inexpensive way to lower the risk of heart disease,” said Dr. JoAnn Manson of Boston's Brigham and Women's Hospital, co-author of the study, who said, “Some kinds of fat are bad for you, but the fat in fish actually lowers cholesterol, helps prevent blood clots that form in heart attacks and lessens the chances for the irregular heart beats that cause about 250,000 sudden deaths a year. Mounting evidence suggests there is an inverse association between fish intake and heart disease in women and men,” said Dr. Manson. “We would recommend people eat more fish as part of a healthy diet.”

Reducing irregular heartbeats could be the most important benefit of fatty acids in fish.

Fish oil supplements
A third study published in the American Heart Association's journal, Circulation, looked at omega-3 fatty acid supplements. Participants who took one gram daily of an omega-3 fatty acid supplement reduced their risk of sudden cardiac death by 42 percent during the three-month follow-up period compared to people who received a placebo. The 11,323 participants in the study ate a Mediterranean-style diet, which is rich in fruits, vegetables, olive oil and fish. Doctors say the analysis shows that reducing irregular heartbeats, which can lead to sudden death, could be the most important benefit of fatty acids in fish.

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Good news for fish lovers

These three new studies have uncovered more evidence that fatty acids found in certain fish are heart-healthy nutrients. Eating fish regularly (especially dark-meat fish such as salmon) or taking fish oil supplements appears to reduce the risk of coronary heart disease safely and cheaply for most people.

“Eating fish regularly or taking fish oil supplements appears to reduce the risk of coronary heart disease.”

The statistics are pretty dramatic. The 17-year study of men with no history of heart disease—published in The New England Journal of Medicine—found that those with the highest blood levels of omega-3 fatty acids were more than 80 percent less likely to die suddenly from heart disease. And the benefits apply to women as well. A 16-year study of almost 85,000 women found that those who ate fish two to four times weekly cut their risk of heart disease by 30 percent, compared with women who rarely ate fish.

These studies provide further evidence of the health benefits of omega-3 fatty acids, but there is still not a lot of hard science that explains the specific biological mechanisms affected by omega-3 fatty acids. We do know that a diet rich in these substances results in a reduction of the formation of blood-clotting cells called platelets. Omega-3 fatty acids can also help lower your levels of triglyceride and LDL (“bad”) cholesterol, which are fatty substances in the blood that can increase your risk of heart disease.

In addition, the fatty acids found in fish can also decrease your risk of sudden death from heart attack or stroke, irregular heartbeat, blood clots and high blood pressure.

What kind and how much?
The best sources of the healthy fatty acids are ocean fish such as salmon, tuna and mackerel. But even if you can't afford these tasty, sometimes expensive fish, canned tuna or sardines may work just as well. The following kinds of fish are rich in omega-3 fatty acids:

Albacore
Black bass
Bluefish
Carp
Channel catfish
Herring
Lake herring
Lake trout
Mackerel
Pompano
Salmon
Tuna (packed in water)
Whitefish

Keep in mind that preparation is also important since baking, broiling or grilling fish is better nutritionally than breading or frying with vegetable oil.

How much fish should you eat? You don't need to have fish every day of the week. The Nurses' Study found women who only consumed fish once a week experienced a 29 percent decline in their chances of developing heart disease.

Also, if you don't like fish or have allergies to certain kinds of fish, supplements are very effective as shown by the study published in Circulation. Participants who took one gram daily of an omega-3 fatty acid supplement reduced their risk of sudden cardiac death by 42 percent.

“A Mediterranean-style diet, rich in fruits, vegetables, olive oil and cold water fish is a good model.”

Moderation is key
The best strategy is to shoot for an overall healthy eating pattern that includes foods from all the major food groups. Eat a variety of fruits, vegetables and grains. Aim for five or more servings of fruits and vegetables and six or more servings of whole grains per day. A Mediterranean-style diet, rich in fruits, vegetables, olive oil and cold water fish is a good model whether you're at risk for heart disease or not.

And don't forget: Fish oil is only a small part of the picture in reducing heart disease. Heart disease is caused by many factors such as smoking, high blood pressure, high blood cholesterol, obesity and lack of physical exercise. To reduce your risk of heart disease, maintain a healthy body weight, don't smoke, exercise and eat a healthy diet of fruits, vegetables, fiber…and fish.

Dr. Foody is a cardiologist at Yale-New Haven Heart Center and Yale-New Haven Hospital, as well as an assistant professor of cardiology at the Yale School of Medicine.