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British Medical Journal

Clinical Articles, Lead Article

Oily fish may reduce stroke risk

Consuming at least two servings of oily fish per week is significantly associated with a reduction in risk of stroke, but the same effect is not found from taking fish-oil supplements, according to analysis published recently in the British Medical Journal.1

Researchers led by Dr Oscar H Franco (University Medical Center, Rotterdam, the Netherlands) reviewed 26 prospective cohort studies and 12 randomised controlled trials involving a total of 794,000 subjects and 34,817 cerebrovascular outcomes.

Participants consuming two to four fish servings a week had a 6% lower risk of cerebrovascular disease compared with those having one or fewer fish servings a week. Participants eating five or more fish servings a week had a 12% lower risk. In a dose-response meta-analysis, an increment of two servings per week of any fish was associated with a 4% reduced risk of cerebrovascular disease.

There was no evidence for similar associations with cerebrovascular disease for long-chain omega 3 fatty acids measured as circulating biomarkers in observational studies or fish-oil supplements in primary- and secondary-prevention trials.

Screen shot 2012-11-15 at 15.05.02Eating more fish may reduce the intake of other less healthy foods, or higher fish intake may be an indicator of a generally healthier diet or higher socioeconomic status, both associated with better vascular health, the authors say.

The findings are “in line with disappointing results” from controlled trials of supplementation with long-chain omega 3 fatty acids for the prevention of coronary heart disease (CHD), say the authors of an accompanying editorial.2

“It seems that the additional benefit of supplementation in patients who are optimally managed may be small,” the authors say. Based on available evidence, it is “reasonable to advise people that eating one or two portions of fish a week could reduce the risk of CHD and stroke,” they add.

“Any benefit of long-chain omega 3 fatty-acid supplementation for the secondary prevention of CHD and stroke is likely to be small,” they conclude. “However, it is possible that patients who are less than optimally medically treated or who have additional risk factors (for example, as a result of comorbidities such as diabetes) may benefit.”


1. Chowdhury R, Stevens S, Gorman D, et al. Association between fish consumption, long-chain omega 3 fatty acids, and risk of cerebrovascular disease: Systematic review and meta-analysis. BMJ 2012.

2. de Goede J and Geleijnse JM. The role of fatty acids from fish in the prevention of stroke. BMJ 2012.

Published on: November 15, 2012

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