Can eating fish help reduce my risk of heart attack and stroke?

Dariush Mozaffarian, MD
Internal Medicine
Omega-3 fatty acids, which are abundant in certain fatty fish, have a range of biologic effects that would lower risk of cardiovascular disease. Data from the Physicians' Health Study showed that people who ate fish once a week were half as likely to die suddenly from a heart attack compared with those who ate fish less than once a month. One year later, a report in The Lancet described a randomized controlled trial in which men who had suffered a heart attack received either a fish oil supplement, 300 mg of vitamin E, both, or neither. Those who received the fish oil supplement had significantly lower rates of heart attack, stroke, or death during the next three and a half years. Sudden death rates dropped by 45%.

Additional support for fish oils comes from a report on nearly 80,000 women in the Nurses' Health Study. This 14-year study found that women who ate fish at least twice a week were half as likely to suffer strokes caused by clots blocking an artery to the brain compared with those who ate fish less than once a month. The study also found that eating one to three servings of fish per month cut the risk of heart disease by 20%.

People who use cholesterol-lowering statin drugs might further reduce their risk of heart problems by getting more omega-3s from fish or pills, according to a large randomized controlled study published in The Lancet. Around 19,000 people with elevated cholesterol levels took a statin alone or with an omega-3 fatty acid supplement. After four and a half years, the people who took the combination had 19% fewer coronary events, such as angina and fatal or nonfatal heart attack, than those who took the statin alone.

Overall, the evidence from these and many other studies indicates that modest consumption of fish, such as 1-2 servings of oily (fatty) fish per week, reduces the risk of dying from coronary heart disease.  The risk of stroke is also lower in observational studies, but this has not yet been confirmed in any randomized trials.
Cut your risk of stroke by one-third just by choosing this for dinner: fish.

But here's the catch: You've gotta choose it three times this week. In a Swedish study, women who ate fish at least three nights a week enjoyed as much as a 33% lower risk of stroke during the 10-year follow-up period.

How does fish downsize stroke risk? More research is needed to clarify the protective mechanisms. But here are a couple of theories: (1) When we eat more fish -- a lean, healthy source of protein -- we crowd out other less-healthful animal proteins, such as red meat laden with artery-clogging saturated fat; and (2) fish is high in taurine, an amino acid that appears to reduce blood pressure and triglycerides in both human and animal studies. And anytime you reduce blood pressure or unhealthful blood fats, that's good news for your stroke risk.

Interestingly, it appeared that lean fish provided a better stroke-reduction benefit than did fatty fish in the study -- an unusual finding because fatty fish have much higher concentrations of stroke-thwarting omega-3 fats. But the researchers suspect that the stroke-protective benefits from the fattier fish may have been neutralized in this particular study by preparation methods. In Sweden, fatty fish like salmon and herring are often eaten in a salt-cured form -- not a particularly blood-pressure-friendly way to serve it. So don't muddy up your fish benefits by dousing your salmon with salt or frying it in butter.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.