Fish Consumption and Cardiovascular Health: A Systematic Review

Published:January 11, 2021DOI:


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pan XF
        • Marklund M
        • Wu JH.
        Fish consumption for cardiovascular health: benefits from long-chain omega-3 fatty acids versus potential harms due to mercury.
        Heart. 2019; 105: 1384-1385
        • He K
        Long-chain omega-3 polyunsaturated fatty acids and prevention of cardiovascular disease–eat fish or take fish oil supplement?.
        Prog Cardiovasc Dis. 2009; 52: 95-114
        • Ajith TA
        • Jayakumar TG.
        Omega-3 fatty acids in coronary heart disease: recent updates and future perspectives.
        Clin Exp Pharmacol Physiol. 2019; 46: 11-18
        • Yang B
        • Shi MQ
        • Li ZH
        • Yang JJ
        • Li D
        Fish, long-chain n-3 PUFA and incidence of elevated blood pressure: a meta-analysis of prospective cohort studies.
        Nutrients. 2016; 8: 58
        • Zhao W
        • Tang H
        • Yang X
        • et al.
        Fish consumption and stroke risk: a meta-analysis of prospective cohort studies.
        J Stroke Cerebrovasc Dis. 2019; 28: 604-611
        • Guasch-Ferré M
        • Babio N
        • Martínez-González MA
        • et al.
        Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease.
        Am J Clin Nutr. 2015; 102: 1563-1573
        • Burr ML
        • Fehily AM
        • Rogers S
        • Welsby E
        • King S
        • Sandham S.
        Diet and Reinfarction Trial (DART): design, recruitment, and compliance.
        Eur Heart J. 1989; 10: 558-567
        • Mozaffarian D
        • Prineas RJ
        • Stein PK
        • Siscovick DS.
        Dietary fish and n-3 fatty acid intake and cardiac electrocardiographic parameters in humans.
        J Am Coll Cardiol. 2006; 48: 478-484
        • Mozaffarian D
        • Stein PK
        • Prineas RJ
        • Siscovick DS.
        Dietary fish and omega-3 fatty acid consumption and heart rate variability in us adults.
        Circulation. 2008; 117: 1130-1137
        • London B
        • Albert C
        • Anderson ME
        • et al.
        Omega-3 fatty acids and cardiac arrhythmias: prior studies and recommendations for future research: A report from the national heart, lung, and blood institute and office of dietary supplements omega-3 fatty acids and their role in cardiac arrhythmogenesis workshop.
        Circulation. 2007; 116: e320-e335
        • McLennan PL
        • Abeywardena MY.
        Membrane basis for fish oil effects on the heart: Linking natural hibernators to prevention of human sudden cardiac death.
        J Membr Biol. 2005; 206: 85-102
        • de Mello VD
        • Schwab U
        • Kolehmainen M
        • et al.
        A diet high in fatty fish, bilberries and wholegrain products improves markers of endothelial function and inflammation in individuals with impaired glucose metabolism in a randomised controlled trial: the Sysdimet study.
        Diabetologia. 2011; 54: 2755-2767
        • Kris-Etherton PM
        • Hill AM.
        N-3 fatty acids: food or supplements?.
        J Am Diet Assoc. 2008; 108: 1125-1130
        • Visioli F
        • Risé P
        • Barassi MC
        • Marangoni F
        • Galli C.
        Dietary intake of fish vs. Formulations leads to higher plasma concentrations of n-3 fatty acids.
        Lipids. 2003; 38: 415-418
        • Harris WS
        • Pottala JV
        • Sands SA
        • Jones PG.
        Comparison of the effects of fish and fish-oil capsules on the n 3 fatty acid content of blood cells and plasma phospholipids.
        Am J Clin Nutr. 2007; 86: 1621-1625
        • Mohanty BP
        • Mahanty A
        • Ganguly S
        • Mitra T
        • Karunakaran D
        • Anandan R.
        Nutritional composition of food fishes and their importance in providing food and nutritional security.
        Food Chem. 2019; 293: 561-570
        • Lu Z
        • Chen TC
        • Zhang A
        • et al.
        An evaluation of the vitamin D3 content in fish: is the vitamin D content adequate to satisfy the dietary requirement for vitamin D?.
        The J Steroid Biochem Mol Biol. 2007; 103: 642-644
        • Ju W
        • Li X
        • Li Z
        • et al.
        The effect of selenium supplementation on coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.
        J Trace Elem Med Biol. 2017; 4: 8-16
        • Manson JE
        • Bassuk S
        • Cook NR
        • et al.
        Vitamin D, marine n-3 fatty acids, and primary prevention of cardiovascular disease current evidence.
        Circ Res. 2020; 126: 112-128
        • Peppa M
        • Raptis SA.
        Advanced glycation end products and cardiovascular disease.
        Curr Diabetes Rev. 2008; 4: 92-100
        • Hegab Z
        • Gibbons S
        • Neyses L
        • Mamas MA.
        Role of advanced glycation end products in cardiovascular disease.
        World J Cardiol. 2012; 4: 90-102
        • Guallar-Castillón P
        • Rodríguez-Artalejo F
        • Lopez-Garcia E
        • et al.
        Consumption of fried foods and risk of coronary heart disease: Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study.
        BMJ. 2012; 344: e363
        • Fillion L
        • Henry CJ.
        Nutrient losses and gains during frying: a review.
        Int J Food Sci Nutr. 1998; 49: 157-168
        • Pokorn J
        • Pánek J
        • Trojáková L.
        Effect of food component changes during frying on the nutrition value of fried food.
        Forum Nutr. 2003; 56: 348-350
        • Candela M
        • Astiasaran I
        • Bello J.
        Deep-fat frying modifies high-fat fish lipid fraction.
        J Agric Food Chem. 1998; 46: 2793-2796
        • Guallar-Castillón P
        • Rodríguez-Artalejo F
        • Fornés NS
        • et al.
        Intake of fried foods is associated with obesity in the cohort of Spanish adults from the European Prospective Investigation into Cancer and Nutrition.
        Am J Clin Nutr. 2007; 86: 198-205
        • de Souza RJ
        • Mente A
        • Maroleanu A
        • et al.
        Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies.
        BMJ. 2015; 351 (h3978)
        • Li A
        • Ha Y
        • Wang F
        • Li W
        • Li Q.
        Determination of thermally induced trans-fatty acids in soybean oil by attenuated total reflectance fourier transform infrared spectroscopy and gas chromatography analysis.
        J Agric Food Chem. 2012; 60: 10709-10713
        • Mozaffarian D
        • Longstreth Jr, WT
        • Lemaitre RN
        • et al.
        Fish consumption and stroke risk in elderly individuals: the cardiovascular health study.
        Arch Intern Med. 2005; 165: 200-206
        • Goldberg T
        • Cai W
        • Peppa M
        • et al.
        Advanced glycoxidation end products in commonly consumed foods.
        J Am Diet Assoc. 2004; 104: 1287-1291
        • Dybing E
        • Sanner T.
        Risk assessment of acrylamide in foods.
        Toxicol Sci. 2003; 75: 7-15
        • Huang M
        • Jiao J
        • Wang J
        • Chen X
        • Zhang Y.
        Associations of hemoglobin biomarker levels of acrylamide and all-cause and cardiovascular disease mortality among U.S. Adults: national health and nutrition examination survey 2003-2006.
        Environ Pollut. 2018; 238: 852-858
        • Liu ZM
        • Tse LA
        • Ho SC
        • et al.
        Dietary acrylamide exposure was associated with increased cancer mortality in chinese elderly men and women: a 11-year prospective study of Mr. and Ms. OS Hong Kong.
        J Cancer Res Clin Oncol. 2017; 143: 2317-2326
        • Wallin A
        • Orsini N
        • et al.
        Fish consumption in relation to myocardial infarction, stroke and mortality among women and men with type 2 diabetes: A prospective cohort study.
        Clin Nutr. 2018;
        • Rhee Jinnie
        • Kim Eunjung
        • et al.
        Fish Consumption, Omega-3 Fatty Acids, and Risk of Cardiovascular Disease.
        Am J Prev Med. 2016;
        • Würtz AM
        • Hansen MD
        • et al.
        Substitution of meat and fish with vegetables or potatoes and risk of myocardial infarction.
        Br J Nutr. 2016;
        • Gammelmark A
        • Nielsen MS
        • et al.
        Association of fish consumption and dietary intake of marine n-3 PUFA with myocardial infarction in a prospective Danish cohort study.
        Br J Nutr. 2016;
        • Nahab F
        • Pearson K
        • et al.
        Dietary fried fish intake increases risk of CVD: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
        Public Health Nutr. 2016;
        • Haring B
        • Gronroos N
        • et al.
        Dietary protein intake and coronary heart disease in a large community based cohort: results from the Atherosclerosis Risk in Communities (ARIC) study [corrected].
        PLoS One. 2014;
        • Kühn T
        • Teucher B
        • et al.
        Fish consumption and the risk of myocardial infarction and stroke in the German arm of the European Prospective Investigation into Cancer and Nutrition (EPIC-Germany).
        Br J Nutr. 2013;
        • Dilis V
        • Katsoulis M
        • et al.
        Mediterranean diet and CHD: the Greek European Prospective Investigation into Cancer and Nutrition cohort.
        Br J Nutr. 2012;
        • Wennberg M
        • Bergdahl IA
        • et al.
        Fish consumption and myocardial infarction: a second prospective biomarker study from northern Sweden.
        Am J Clin Nutr. 2011;
        • Bjerregaard LJ
        • Joensen AM
        • et al.
        Fish intake and acute coronary syndrome.
        Eur Heart J. 2010;
        • Bernstein AM
        • Sun Q
        • et al.
        Major Dietary Protein Sources and the Risk of Coronary Heart Disease in Women.
        Circulation. 2010;
        • de Goede J
        • Geleijnse JM
        • et al.
        Marine (n-3) fatty acids, fish consumption, and the 10-year risk of fatal and nonfatal coronary heart disease in a large population of Dutch adults with low fish intake.
        J Nutr. 2010;
        • Holmberg S
        • Thelin A
        • et al.
        Food choices and coronary heart disease: a population based cohort study of rural Swedish men with 12 years of follow-up.
        Int J Environ Res Public Health. 2009;
        • Buckland G
        • González C
        • et al.
        Adherence to the Mediterranean Diet and Risk of Coronary Heart Disease in the Spanish EPIC Cohort Study.
        American Journal of Epidemiology. 2009;
        • Yamagishi K
        • Iso H
        • et al.
        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.
        Journal of the American College of Cardiology. 2008;
        • Iso H
        • Kobayashi M
        • et al.
        Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I.
        Circulation. 2006;
        • Osler M
        • Andreasen A
        • et al.
        No inverse association between fish consumption and risk of death from all-causes, and incidence of coronary heart disease in middle-aged, Danish adults.
        Journal of Clinical Epidemiology. 2003;
        • Mozaffarian D
        • Lemaitre R
        • et al.
        Cardiac Benefits of Fish Consumption May Depend on the Type of Fish Meal ConsumedThe Cardiovascular Health Study.
        Circulation. 2003;
        • Yuan J
        • Ross R
        • et al.
        Fish and Shellfish Consumption in Relation to Death from Myocardial Infarction among Men in Shanghai, China.
        American Journal of Epidemiology. 2001;
        • Daviglus M
        • Stamler J
        • et al.
        Fish Consumption and the 30-Year Risk of Fatal Myocardial Infarction.
        NEJM. 1997;
        • Morris M
        • Manson J
        • et al.
        Fish Consumption and Cardiovascular Disease in the Physicians’ Health Study: A Prospective Study.
        American Journal of Epidemiology. 1995;
        • Ascherio A
        • Rimm E
        • et al.
        Dietary Intake of Marine n-3 Fatty Acids, Fish Intake, and the Risk of Coronary Disease among Men.
        N Engl J Med. 1995;
        • Albert C
        • Hennekens C
        • et al.
        Fish Consumption and Risk of Sudden Cardiac Death.
        JAMA. 1998;