Fish and cardiovascular disease prevention: time for a closer collaboration between basic science and clinical research

Demosthenes B. Panagiotakos, Matina Kouvari

Research output: Contribution to journalComment/debatepeer-review

2 Citations (Scopus)


Fish and shellfish (hereafter referred to as fish) remain one of the most investigated food groups in dietetics and prevention of chronic non-communicable diseases, with cardiovascular disease (CVD) being at or near the top of the list.1 The Seven Countries Study stands as the very first that revealed the cardioprotective effects of fish consumption.2 Since then fish and their relation with vascular health have been the subject of considerable interest in many observational and interventional studies either separately examined or as a part of a healthy dietary pattern, like the Mediterranean diet. Even if results are still in some cases inconclusive, there is an established relation between frequent fish consumption and lower CVD risk.3 The beneficial effects of fish are mainly attributed to their high content in polyunsaturated fatty acids (PUFAs), represented by eicosapentaenoic (EPA) (20:5n–3) and docosahexaenoic (DHA) (22:6n–3) acids, without excluding the positive impact of other fish nutrients such as vitamin D, riboflavin, iodine, calcium, phosphorus, magnesium, potassium, zinc, and iron.1 To this issue, dietary guidelines in CVD prevention strongly recommend the consumption of fish one to two times per week, with one of which being an oily fish (e.g. salmon, sardines, tuna, mackerel)4 which may in turn provide 1.5–2 g of EPA and DHA as a preventive step towards CVD.5 Despite the recognition of fish as an indispensable part of cardioprotective dietary patterns, cohort studies present mixed outcomes regarding the actual added value of fish or oily fish consumption in relation to CVD events. In this context, observational cohorts suggest modest protective associations of moderate fish consumption (approximately ≥2 servings/week) with fatal CVD events or even neutral associations in case of total CVD events.3 On the other side, in case of individuals at high CVD risk, including patients with diabetes, a clear protective effect attributed to fish consumption has been suggested.6 When it comes to marine n-3 supplementation, recent meta-analyses of interventional studies suggest from a neutral7 to a clear protective effect.8
Original languageEnglish
Pages (from-to)94-96
Number of pages3
JournalCardiovascular Research
Issue number8
Publication statusPublished - 1 Jul 2021


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