Fish consumption and coronary artery disease in China.

in China To the Editor: As Dallongeville et al1 indicated in the introduction of their article, it has been well established that fish consumption has a protective cardiovascular effect. To the existing theories of this association, the authors added another: fish consumption is associated with decreased heart rate and thus lower risk of sudden death because heart rate is positively associated with risk of sudden death. The protective effect of fish consumption on coronary artery disease was known in China nearly four decades ago. In an epidemiological study on the regional differences in incidence of coronary artery disease in people over 40 years of age in China, which was carried out by the Cardiovascular Institute, Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China, it was noted that the lowest incidence of coronary artery disease (0.6%) was in the fishermen in Choushan archipelago (Table).2 That eating fish has a beneficial effect and eating animal fat has an unfavorable influence on the incidence of coronary artery disease is further revealed by two observations noted in the Table. First, the incidence of coronary artery disease is lower in Kwangtung (now called Guangdong) in southern China (2.01%) than in Peking (now called Beijing) in northern China (4.4%).2 The southerners eat more fish than the northerners not only because the former have more ready access to fish in the water (Guangdong is a coastal province) but because the northerners have to eat more animal fat to meet the fuel requirements necessitated by the colder weather in the north, and Beijing is inland. The second and more important observation is that in the same province in China, the more animal fat there is in the diet, the higher the incidence of coronary artery disease. In Sinkiang (now called Xinjiang), the nomads, who eat predominantly animal fat, have nearly eight times (19.75%) as much coronary artery disease as the cadres (2.46%).2 This observational study from China2 was recently confirmed by a prospective study from Shanghai, China.3 Two additional studies published in June in this journal4,5 rendered further support to this association. Therefore, the positive association between fish consumption and coronary artery disease and/or sudden death is not a fishy story after all.