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. 2020 Mar 4:368:m456.
doi: 10.1136/bmj.m456.

Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study

Zhi-Hao Li  1 , Wen-Fang Zhong  1 , Simin Liu  2 , Virginia Byers Kraus  3 , Yu-Jie Zhang  1 , Xiang Gao  4 , Yue-Bin Lv  5 , Dong Shen  1 , Xi-Ru Zhang  1 , Pei-Dong Zhang  1 , Qing-Mei Huang  1 , Qing Chen  1 , Xian-Bo Wu  1 , Xiao-Ming Shi  5 , Dong Wang  6 , Chen Mao  7
Affiliations

Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study

Zhi-Hao Li et al. BMJ. .

Abstract

Objectives: To evaluate the associations of habitual fish oil supplementation with cardiovascular disease (CVD) and mortality in a large prospective cohort.

Design: Population based, prospective cohort study.

Setting: UK Biobank.

Participants: A total of 427 678 men and women aged between 40 and 69 who had no CVD or cancer at baseline were enrolled between 2006 and 2010 and followed up to the end of 2018.

Main exposure: All participants answered questions on the habitual use of supplements, including fish oil.

Main outcome measures: All cause mortality, CVD mortality, and CVD events.

Results: At baseline, 133 438 (31.2%) of the 427 678 participants reported habitual use of fish oil supplements. The multivariable adjusted hazard ratios for habitual users of fish oil versus non-users were 0.87 (95% confidence interval 0.83 to 0.90) for all cause mortality, 0.84 (0.78 to 0.91) for CVD mortality, and 0.93 (0.90 to 0.96) for incident CVD events. For CVD events, the association seemed to be stronger among those with prevalent hypertension (P for interaction=0.005).

Conclusions: Habitual use of fish oil seems to be associated with a lower risk of all cause and CVD mortality and to provide a marginal benefit against CVD events among the general population.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme, Construction of High-level University of Guangdong, US National Institutes of Health/National Institute on Ageing, and National Natural Science Foundation of China for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Association of fish oil supplement use and the risk of all cause mortality stratified by potential risk factors. Results were adjusted for age, sex, Townsend Deprivation Index, assessment centre (22 categories), ethnicity (white, black, Asian, Chinese, mixed, or other ethnic group), household income (<£18 000 (€21 489; $23 253), £18 000-£30 999, £31 000-£51 999, £52 000-£100 000, or >£100 000), body mass index, fruit consumption (<2.0, 2.0-3.9, or ≥4.0 servings/day), vegetable consumption (<2.0, 2.0-3.9, or ≥4.0 servings/day), oily fish consumption (<2 or ≥2 times/week), smoking status (never, former, or current), alcohol consumption (never, 1-2, 3-4, or ≥5 times/week), physical activity (<150 or ≥150 min/week), diabetes (yes or no), hypertension (yes or no), longstanding illness (yes or no), antihypertensive drug use (yes or no), statin use (yes or no), insulin treatment use (yes or no), aspirin use (yes or no), vitamin supplementation (yes or no), and mineral and other dietary supplementation (yes or no)
Fig 2
Fig 2
Associations of fish oil supplement use and the risk of cardiovascular events and cardiovascular mortality stratified by potential risk factors. Results were adjusted for age, sex, Townsend Deprivation Index, assessment centre (22 categories), ethnicity (white, black, Asian, Chinese, mixed, or other ethnic group), household income (<£18 000 (€21 489; $23 253), £18 000-£30 999, £31 000-£51 999, £52 000-£100 000, or >£100 000), body mass index, fruit consumption (<2.0, 2.0-3.9, or ≥4.0 servings/day), vegetable consumption (<2.0, 2.0-3.9, or ≥4.0 servings/day), oily fish consumption (<2 or ≥2 times/week), smoking status (never, former, or current), alcohol consumption (never, 1-2, 3-4, or ≥5 times/week), physical activity (<150 or ≥150 min/week), diabetes (yes or no), hypertension (yes or no), longstanding illness (yes or no), antihypertensive drug use (yes or no), statin use (yes or no), insulin treatment use (yes or no), aspirin use (yes or no), vitamin supplementation (yes or no), and mineral and other dietary supplementation (yes or no)
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