Studies evaluating fish consumption and cardiovascular disease events have shown inconsistent results. We performed a systematic review of peer-reviewed publications from an extensive query of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception to September 2020 for observational studies that reported the association between fish consumption and cardiovascular disease events. We identified and reviewed 24 studies related to fish consumption and the effect on cardiovascular outcomes. The study population included a total of 714,526 individuals and multiple cohorts from several countries. We found that nonfried fish consumption is probably associated with a reduced risk of overall cardiovascular disease events and myocardial infarction risk. In contrast, fried fish consumption is probably associated with an increased risk of overall cardiovascular disease events and myocardial infarction risk. No studies to date have shown any significant association between fish consumption and stroke. Our analysis suggests that fish consumption may reduce cardiovascular disease events, but fried fish consumption was associated with an increased risk of cardiovascular events.
Introduction
Fish contains multiple nutrients, such as omega-3 long-chain polyunsaturated fatty acids, protein, vitamin D, vitamin B, calcium, selenium, and other components.1.,2 Omega-3 long-chain polyunsaturated fatty acids are known to have anti-inflammatory and lipid-lowering effects, as well as antihypertensive effects.3 Previous studies evaluating the impact of fish consumption on cardiovascular disease events have shown inconsistent results.1,4,5 Therefore, our aim in this investigation was to systematically review the existing literature about the relationship between fish consumption and cardiovascular disease events in human studies in order to inform the integration of fish into a well-balanced diet.
Methods
We performed a systematic review of peer-reviewed publications from an extensive query of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception to September 2020. No restrictions were placed on language or publication date. Search strategy included MESH headings and keywords such as “fish,” “fish consumption,” “cardiovascular disease,” “cardiovascular events,” “diabetes,” “hypertension,” “high blood pressure,” “hyperlipidemia,” “dyslipidemia,” “arrhythmia,” “coronary artery disease,” “ischemic heart disease,” “acute myocardial infarct,” “acute coronary syndrome,” “stroke,” “heart failure,” “cardiac failure,” “cardiac insufficiency” and “cardiomyopathy.” We identified studies based on appropriate design (observational study, prospective cohort study, randomized controlled trial, or case control design) with the necessary exposure (fish consumption). We excluded animal studies, editorials, and reviews. Two investigators independently reviewed abstracts for potentially eligible studies. Full text reports were then assessed for eligibility, and disagreements were resolved by consensus discussion. We were unable to perform meta-analysis of the results due to significant heterogeneity among the included studies related to intervention, comparison, outcomes, and timing. Instead, we qualitatively synthesized the results and summarized key features and characteristics (e.g., study populations, design, intervention, outcomes, and conclusions) of the included studies.
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-Chayakrit Krittanawong, MD, Ameesh Isath, MBBS, Joshua Hahn, MD, Zhen Wang, PhD, Bharat Narasimhan, MD, Scott L. Kaplin, MD, Hani Jneid, MD, Salim S. Virani, MD, PhD, W.H. Wilson Tang, MD
