Fish, ω-3 Polyunsaturated Fatty Acids, and Mortality From Cardiovascular Diseases in a Nationwide Community-Based Cohort of Japanese Men and Women: The JACC (Japan Collaborative Cohort Study for Evaluation of Cancer Risk) Study

Objectives The objective of our study was to test the hypothesis that fish or ω-3 polyunsaturated fatty acids (PUFA) intakes would be inversely associated with risks of mortality from ischemic heart disease, cardiac arrest, heart failure, stroke, and total cardiovascular disease. Background Data on associations of dietary intake of fish and of ω-3 PUFA with risk of cardiovascular disease among Asian societies have been limited. Methods We conducted a prospective study consisting of 57,972 Japanese men and women. Dietary intakes of fish and ω-3 PUFA were determined by food frequency questionnaire, and participants were followed up for 12.7 years. Hazard ratios and 95% confidence intervals were calculated according to quintiles of fish or ω-3 PUFA intake. Results We observed generally inverse associations of fish and ω-3 PUFA intakes with risks of mortality from heart failure (multivariable hazard ratio [95% confidence interval] for highest versus lowest quintiles = 0.76 [0.53 to 1.09] for fish and 0.58 [0.36 to 0.93] for ω-3 PUFA). Associations with ischemic heart disease or myocardial infarction were relatively weak and not statistically significant after adjustment for potential risk factors. Neither fish nor ω-3 PUFA dietary intake was associated with mortality from total stroke, its subtypes, or cardiac arrest. For mortality from total cardiovascular disease, intakes of fish and ω-3 PUFA were associated with 18% to 19% lower risk. Conclusions We found an inverse association between fish and ω-3 PUFA dietary intakes and cardiovascular mortality, especially for heart failure, suggesting a protective effect of fish intake on cardiovascular diseases.