Table 1.
Studies of primary prevention of AF by consumption of fish and marine n−3 PUFA.
| Reference | Study population (mean age at entry) | n | Incident cases of AF | Study design | Exposure | Outcome | Follow-up | Main results |
|---|---|---|---|---|---|---|---|---|
| Mozaffarian et al. (2004), US | Cardiovascular Health Study, adults (73 years) | 4815 | 980 | Cohort study | Fish consumption based on diet information | Incident AF | 12 years | 28% lower risk of AF with intake 1–4 times per week of tuna or other broiled or baked fish (HR 0.72, 95% CI 0.58–0.91, p = 0.005), and 31% lower risk with intake ≥5 times per week (HR 0.69, 95% CI 0.52–0.91, p = 0.008) compared with <1 time per month |
| Frost and Vestergaard (2005), Denmark | Diet Cancer and Health Study, adults (56 years) | 47949 | 556 | Cohort study | n−3 PUFA consumption based on diet information | Incident AF | 5.7 years | 34% higher risk of AF was seen when comparing highest vs. lowest quintile of n−3 PUFA intake (HR 1.34, 95% CI 1.02–1.76), whereas no association was seen in quintiles 2, 3, and 4 (HR 0.86, 1.08, 1.01 respectively) |
| Brouwer et al. (2006), Holland | Rotterdam Study, adults (67 years) | 5184 | 312 | Cohort study | Fish and n−3 PUFA consumption based on diet information | Incident AF | 6.4 years | A non-significant higher risk of AF comparing highest vs. lowest tertile of n−3 PUFA intake (HR 1.18, 95% CI 0.88–1.57) |
| Macchia et al. (2008), Italy | Patients after myocardial infarction (65 years) | 3242 (215 in n−3 group) | 471 | Population study on registry data | Prescription database records on n−3 PUFA | Incident AF | 1 year | Relative risk reduction of 81% in hospitalization for AF (HR 0.19, 95% CI 0.07–0.51) |
| Virtanen et al. (2009), Finland | Kuopio IHD Risk Factor Study, males (53 years) | 2174 | 240 | Cohort study | Serum n−3 PUFA as a measure of dietary consumption | Incident AF | 17.7 years | 35% lower risk of AF comparing highest vs. lowest quartile of n−3 PUFA (HR 0.65, 95% CI 0.44–0.96). DHA but not EPA was associated with a lower risk of AF (HR 0.62, 95% CI 0.42–0.92) |
| Berry et al. (2010), US | Women’s Health Initiative, postmenopausal women (63 years) | 44720 | 378 | Cohort study | Fish consumption based on diet information | Incident AF at 3 and 6 year visit | 6 years | A non-significant higher risk of AF for highest vs. lowest quartile of fish intake (OR 1.17, 95% CI 0.88–1.57) |
| Shen et al. (2011), US | Framingham Heart Study, adults (62 years) | 4526 | 296 | Cohort study | Fish consumption based on diet information | Incident AF | 4 years | No association. In exploratory subgroup analyses, >4 servings of fish/week (5 cases and 21 individuals at risk) was significantly associated with higher AF risk compared with consumption of <1 serving of fish/week (HR 6.53, 95% CI 2.65–16.06, p < 0.001) |
AF, atrial fibrillation; n−3 PUFA, marine n−3 polyunsaturated fatty acids; EPA, eicosapentaenoic acid; DHA, docosahexanoic acid; HR, hazard ratio; OR, odds ratio; CI, confidence interval.