This study was conducted to examine the effect of fish consumption on the risk of acute coronary syndrome (ACS) in a large prospective study in Denmark. In addition, information on fish consumption was obtained using a detailed and carefully validated food frequency questionnaire allowing to separate the effects of fish high vs. low in n-3 polyunsaturated fatty acids (PUFA) to be investigated. Within the study cohort of 54 226 participants, a total of 1122 cases of ACS occured over a mean follow-up period of 7.6 years. Results showed that intake of fatty fish was associated with a significant 30% lower risk of ACS in men when comparing subjects in the lowest quintile (≤ 6 g fatty fish/day) with those in the higher quintiles of intake. There did not seem to be any additional benefits observed for higher intakes. Among men, no association was observed for lean fish intake. Results among women were less consistent because of very few cases of ACS. In their comment, Yasuda S and Shimokawa H underline the contribution of this study to answer an important question concerning the effect of n-3 PUFA in the primary prevention of “non-fatal” cardiovascular events. They also list several issues which should be examined such as the kind of fish to determine the frequency of consumption and the serving sizes, the effect of fish oil components and the sex differences observed in n-3 PUFA metabolism.
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