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David S. Siscovick, MD, MPH; T. E. Raghunathan, PhD; Irena King, PhD; Sheila Weinmann, PhD; Kristine G. Wicklund, PhD; Jennifer Albright, MPH; Viktor Bovbjerg, MS; Patrick Arbogast, MS; Heidi Smith; Lawrence H. Kushi, ScD; Leonard A. Cobb, MD; Michael K. Copass, MD; Bruce M. Psaty, MD, PhD; Rozenn Lemaitre, PhD, MPH; Barbara Retzlaff, MPH, RD; Marian Childs, PhD; Robert H. Knopp, MD

JAMA. 1995;274(17):1363-1367.

Abstract
Objective.
—To assess whether the dietary intake of long-chain n-3 polyunsaturated fatty acids from seafood, assessed both directly and indirectly through a biomarker, is associated with a reduced risk of primary cardiac arrest.

Design.
—Population-based case-control study.

Setting.
—Seattle and suburban King County, Washington.

Participants
—A total of 334 case patients with primary cardiac arrest, aged 25 to 74 years, attended by paramedics during 1988 to 1994 and 493 population-based control cases and controls, matched for age and sex, randomly identified from the community. All cases and controls were free of prior clinical heart disease, major comorbidity, and use of fish oil supplements.

Measures of Exposure.
—Spouses of case patients and control subjects were interviewed to quantify dietary n-3 polyunsaturated fatty acid intake from seafood during the prior month and other clinical characteristics. Blood specimens from 82 cases (collected in the field) and 108 controls were analyzed to determine red blood cell membrane fatty acid composition, a biomarker of dietary n-3 polyunsaturated fatty acid intake.

Results.
—Compared with no dietary intake of eicosapentaenoic acid (C_20:5n-3) and docosahexaenoic acid (C_22:6n-3), an intake of 5.5 g of n-3 fatty acids per month (the mean of the third quartile and the equivalent of one fatty fish meal per week) was associated with a 50% reduction in the risk of primary cardiac arrest (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.4 to 0.8), after adjustment for potential confounding factors. Compared with a red blood cell membrane n-3 polyunsaturated fatty acid level of 3.3% of total fatty acids (the mean of the lowest quartile), a red blood cell n-3 polyunsaturated fatty acid level of 5.0% of total fatty acids (the mean of the third quartile) was associated with a 70% reduction in the risk of primary cardiac arrest (OR, 0.3; 95% CI, 0.2 to 0.6).

Conclusion.
—Dietary intake of n-3 polyunsaturated fatty acids from seafood is associated with a reduced risk of primary cardiac arrest.

(JAMA. 1995;274:1363-1367)

Author Affiliations
From the Cardiovascular Health Research Unit, Departments of Medicine (Drs Siscovick, Weinmann, Cobb, Copass, Psaty, Lemaitre, Childs, and Knopp, and Mss Albright and Retzlaff), Epidemiology (Drs Siscovick and Psaty and Mr Bovbjerg), and Biostatistics (Mr Arbogast and Ms Smith), University of Washington, Seattle; the Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Drs King and Wicklund); the Institute for Social Research, University of Michigan, Ann Arbor (Dr Raghunathan); and the Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis (Dr Kushi).

Footnotes
Reprint requests to Cardiovascular Health Research Unit, Metropolitan Park 2 Bldg, Suite 1360, 1730 Minor Ave, Seattle, WA 98101 (Dr Siscovick).

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