|Nutrition Evidence Library|
Erkkila AT, Lichtenstein AH, Mozaffarian D, Herrington DM. Fish intake is associated with a reduced progression of coronary artery atherosclerosis in postmenopausal women with coronary artery disease. Am J Clin Nutr. 2004 Sep; 80(3): 626-632
PubMed ID: 15321802
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Research Design and Implementation Rating:
POSITIVE: See Research Design and Implementation Criteria Checklist below.
To examine the relation between fish consumption and the progression of angiographically defined coronary atherosclerosis in a group of post-menopausal women undergoing baseline and three-year follow-up coronary angiography as part of a randomized clinical trial of hormone replacement therapy (HRT).
Description of Study Protocol:
Participants of the Estrogen Replacement and Atherosclerosis trial.
Randomized, double-blind, placebo-controlled trial.
Participants to the hormone therapy and operators of the angiography to the women's dietary habits and temporal sequence of the films.
Hormone replacement of 0.625mg conjugated equine estrogen, 0.625mg conjugated equine estrogen, or placebo.
The normality of continuous variables was checked, and log transformations were applied as needed. Differences in baseline characteristics and nutrient intakes were tested between the different intake categories by using independent-samples T-tests, Wilcoxon's rank-sum test or chi-square test, as appropriate. The association between total fish intake and different types of fish intake was tested by using the test parameters of changes in mean minimum coronary artery diameter and mean percentage stenosis with the use of mixed-model analysis of covariance (ANCOVA). These measurements were adjusted for age, the location of the coronary segment, the time of follow-up, study clinic, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, race, body mass index (BMI), smoking, use of cholesterol-lowering medication, HRT, diabetes and energy intake (model 1). Model 2 included adjustments for the factors in model 1 and energy-adjusted intakes of saturated, monounsaturated and polyunsaturated fats, cholesterol, fiber and alcohol. Further adjustments for blood pressure; serum concentrations of total cholesterol, HDL, LDL, triacylglycerol and inflammatory markers; education and strenuous physical activity were also made. Differences in the development of new lesions were tested with ANCOVA. Spearman correlation coefficients adjusted for BMI were calculated between inflammatory markers and fish intake. A value of P<0.05 (two-tailed) was considered statistically significant.
Data Collection Summary:
Timing of Measurements
Quantitative coronary angiography using standardized techniques. Review and analysis of the paired films was done using validated cine projectors. The reference, minimum and average luminal diameters and degree of stenosis (as a percentage of the reference diameter) were assessed in proximal epicardial segments. Development of a new lesion was defined as the presence of one or more segments with less than 15% stenosis at baseline and an increase of 15 or more percentage points at follow-up.
Dietary intake by a validated, semiquantitative, 126-item food-frequency questionnaire. Energy intakes less than 660kcal and more than 3,500kcal per day or more than 11 food items left blank were excluded. Frequency of fish consumption was calculated by summing the frequency of intake of tuna, dark fish or other fish. Intake of tuna and dark fish were also summed alone to determine long-chain n-3 fatty acid intake.
Description of Actual Data Sample:
Summary of Results:
HRT did not affect the progression of atherosclerosis.
There was no difference in the baseline values for serum lipids, inflammatory markers and blood pressure. Those with two or more servings of fish a week had higher intakes of energy, protein, cholesterol, alcohol and carotene and lower intakes of carbohydrates.
Among the 42% of the women who were diabetic, change in minimum coronary artery diameter was significantly smaller in women who eat two or more servings of fish a week (P=0.02). Mean baseline percentage stenosis was also greater in this group and there was a smaller change (P<0.001).
Women who ate two or more servings of fish a week had significantly fewer new lesions (P= 0.02).
Women who ate one or more servings of tuna or dark fish a week had a smaller change in minimum coronary artery diameter (P=0.02). This association was diminished and limited to diabetic women when adjusted for the factors in model 1. The association became significant when adjusted for the factors in model 2, which suggests an independent effect of tuna and dark fish (P= 0.02). Among diabetic women, baseline stenosis was greater and changes in percentage stenosis were smaller (models 1 and 2) in those who ate one or more servings of tuna and dark-meat fish a week.
Mean baseline minimum coronary artery diameter was smaller and percentage stenosis was greater in the diabetic women who ate one or more servings of "other fish" than those who had lower intakes. In the nondiabetic women, those reporting more than one serving of "other fish" a week had smaller changes in minimum coronary artery diameter and percentage stenosis. There were fewer segments with new lesions in women who consumed one or more servings of "other fish" a week.
Fish intake was inversely correlated with concentrations of vascular adhesion molecule 1 (VAM-1) but there were no correlations with C-reactive protein (CRP), IL-6 and ICAM-1.
Fish consumption was associated with a significantly reduced progression of coronary atherosclerosis in post-menopausal women with coronary artery disease (CAD). This relation was strongest in diabetic women.
Copyright American Dietetic Association (ADA).