STATIN MODIFIES THE ASSOCIATION OF FISH CONSUMPTION WITH RISK OF HEART FAILURE: THE PHYSICIANS’ HEALTH STUDY



Luc Djousse, M.D., Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

Background: While previous studies have reported a lower risk of heart failure (HF) with fish intake or omega-3 fatty acids, it is unclear whether statin modifies the fish-HF relation.

Objective: To test the hypothesis that statin modifies the association of fish consumption with HF risk in male physicians.

Methods: A prospective cohort of 19,020 participants from the Physicians’ Health Study. Frequency of fish consumption was assessed between 1999 and 2002 using a food frequency questionnaire and HF was ascertained through annual follow-up questionnaires with validation in a subsample. We used Cox regression to estimate multivariable adjusted hazard ratios of HF.

Results: During a median follow-up of 11.3 years, 930 cases of HF occurred. The mean age at baseline was 66.4 ± 8.4 years and 34.7% of subjects were using statin. Fish intake was associated with a lower risk of HF only in men using statin: multivariable adjusted hazard ratios (95% CI) were: 1.0 (ref), 0.63 (0.42-0.96), 0.55 (0.37-0.82), and 0.54 (0.36-0.81) for fish consumption of <1/Mo, 1-3/Mo, 1/week, and 2+/week, respectively, among men receiving statin treatment (p for linear trend: 0.015), after adjustment for age, BMI, alcohol use, smoking, exercise, and history of coronary artery disease, hypertension, diabetes, and atrial fibrillation( p interaction statin x fish intake 0.009). In a secondary analysis, we observed an inverse and nonlinear relation between dietary marine omega-3 fatty acids with HF [HR (95% CI): 1.0 (ref), 0.70 (0.50-0.99), 0.89 (0.64-1.23), 0.68 (0.48-0.96), and 0.78 (0.56-1.07) across consecutive quintiles of dietary omega-3 fatty acids] among men using statin and no relation in men not using statin (p interaction statin x dietary omega-3 = 0.08).

Conclusions: Our data suggest that statin modifies the association of fish consumption and dietary marine omega-3 with HF risk by statin in US male physicians.