Heart disease and stroke are mainly consequences of atherosclerosis and high blood pressure (hypertension). Heart disease is sometimes included in the broader category of atherosclerotic and hypertensive diseases. Risk factors for heart disease and stroke have been well established for many years. Distinct from age, family history, and possible genetic determinants are modifiable risk factors that cause heart attacks and strokes, including high blood cholesterol, high blood pressure, smoking, and diabetes. Behaviors that contribute to development of risk factors for heart disease, partly by causing obesity, include adverse dietary patterns and physical inactivity.

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Social and environmental conditions that may determine such behavioral patterns, in turn, include education and income, cultural influences, family and personal habits, and opportunities to make favorable choices.For example, dietary patterns result from the influences of food production policies, marketing practices, product availability, cost, convenience, knowledge, choices that affect health, and preferences that are often based on early-life habits. Because many aspects of behavior are clearly beyond the control of the individual, the scope of heart disease and Stroke and stroke prevention, from the public health perspective, extends far beyond the individual or the patient. Thus, a comprehensive public health strategy for heart disease prevention must address the broader determinants of risk and disease burden as they affect both the population as a whole and particular groups of special concern, including those determinants that make healthier choices more likely for defeating heart disease.

Observational studies have examined the relationship between fish consumption and coronary heart disease (CHD) risk, but none has had adequate statistical power to support a conclusion. Whelton and associates pooled the data available from multiple observational studies about the consumption of fish and fish oils.

A total of 19 cohort and case-control studies were included in the analysis. All studies were conducted in adult humans, used an observational case-control or cohort study design, compared a group who regularly consumed fish with a group who consumed little or no fish, included CHD as an outcome, and reported the association of fish consumption categories with CHD as a relative risk, hazard ratio, or odds ratio. Fish consumption was recorded in different ways in the studies, and a dietitian converted the quantity of fish consumed to the number of servings consumed weekly.

The pooled relative risk of fatal CHD in persons consuming any amount of fish versus those who consumed little or no fish was 0.83 (95 percent confidence interval, 0.76 to 0.90; P < .005). An inverse relationship was noted between fish consumption and fatal CHD in all but one subgroup. This inverse relationship was more striking in persons consuming two or more servings of fish per week compared with those who ate fewer than two servings per week. The protective effect of fish consumption was slightly greater in women than in men.

The authors conclude that fish consumption is associated with a significantly lower rate of fatal and total CHD. Recommendations of increased fish consumption may be useful in both primary and secondary CHD prevention.