title: Fish consumption and stroke risk in elderly individuals: the cardiovascular health study.
abstract: BACKGROUND
  Associations between fish consumption and stroke risk have been inconsistent, possibly because of the differences in types of fish meals consumed. Additionally, such relationships have not been specifically evaluated in the elderly, in whom disease burden may be high and diet less influential.
  
  
  METHODS
  Among 4775 adults 65 years or older (range, 65-98 years) and free of known cerebrovascular disease at baseline in 1989-1990, usual dietary intake was assessed using a food frequency questionnaire. In a subset, consumption of tuna or other broiled or baked fish, but not fried fish or fish sandwiches (fish burgers), correlated with plasma phospholipid long-chain n-3 fatty acid levels. Incident strokes were prospectively ascertained.
  
  
  RESULTS
  During 12 years of follow-up, participants experienced 626 incident strokes, including 529 ischemic strokes. In multivariate analyses, tuna/other fish consumption was inversely associated with total stroke (P = .04) and ischemic stroke (P = .02), with 27% lower risk of ischemic stroke with an intake of 1 to 4 times per week (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55-0.98) and 30% lower risk with intake of 5 or more times per week (HR, 0.70; 95% CI, 0.50-0.99) compared with an intake of less than once per month. In contrast, fried fish/fish sandwich consumption was positively associated with total stroke (P = .006) and ischemic stroke (P = .003), with a 44% higher risk of ischemic stroke with consumption of more than once per week (HR, 1.44; 95% CI, 1.12-1.85) compared with consumption of less than once per month. Fish consumption was not associated with hemorrhagic stroke.
  
  
  CONCLUSIONS
  Among elderly individuals, consumption of tuna or other broiled or baked fish is associated with lower risk of ischemic stroke, while intake of fried fish or fish sandwiches is associated with higher risk. These results suggest that fish consumption may influence stroke risk late in life; potential mechanisms and alternate explanations warrant further study.
authors.affiliation: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard School of Public Health, Boston, MA, USA. dmozaffa@hsph.harvard.edu
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Rozenn N
authors.initials: RN
authors.lastname: Lemaitre
authors.forename: Teri A
authors.initials: TA
authors.lastname: Manolio
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D015331:Cohort Studies; D016001:Confidence Intervals; D004032:Diet; D015525:Fatty Acids, Omega-3 / Q000097:blood*; D005260:Female; D005395:Fish Oils; D005399:Fishes; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D011336:Probability; D016016:Proportional Hazards Models; D018570:Risk Assessment; D017747:Seafood; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014481:United States
chemical_list: D015525:Fatty Acids, Omega-3; D005395:Fish Oils