The association between dietary omega-3 fatty acids and cardiovascular death: The Singapore Chinese Health Study

Angela S. Koh, An Pan, Renwei Wang, Andrew O. Odegaard, Mark A Pereira, Jian Min Yuan, Woon Puay Koh

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Background: Although studies suggest that omega-3 fatty acids intake may reduce cardiovascular disease (CVD) mortality risk, few studies have differentiated dietary eicosapentaenoic/docosahexaenoic acid (EPA/DHA) from alphalinolenic acid (ALA), and epidemiological research in Asian populations is limited. Methods: The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998. Usual diet was measured at recruitment using a validated semiquantitative foodfrequency questionnaire, and mortality information was identified via registry linkage up to 31 December 2011. Cox proportional hazard models were used to calculate hazard ratios (HRs) with adjustment for potential confounders. Results: We documented 4780 cardiovascular deaths (including 2697 coronary heart disease (CHD) deaths and 1298 stroke deaths) during 890,473 person-years of follow up. Omega-3 fatty acids intake was monotonically associated with reduced risk of cardiovascular mortality. Compared to the lowest quartile, the HR was 0.88 (95% confidence interval, CI, 0.81-0.96), 0.88 (95% CI 0.80-0.97), and 0.83 (95% CI 0.74-0.92) for the second, third, and highest quartile, respectively (p-trend<0.003). Both EPA/DHA and ALA were independently associated with reduced risk of cardiovascular mortality: HR comparing extreme quartiles was 0.86 (95% CI 0.77-0.96, p-trend =0.002) and 0.81 (95% CI 0.73-0.90, p-trend <0.001), respectively. The associations were similar for deaths from CHD and stroke and persisted in participants who were free of CVD at baseline. Conclusions: Higher intakes of marine (EPA/DHA) and plant (ALA) omega-3 fatty acids are both associated with reduced risk of cardiovascular mortality in a Chinese population.

Original languageEnglish (US)
Pages (from-to)364-372
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Issue number3
StatePublished - Mar 14 2015

Bibliographical note

Funding Information:
This work was supported by the US National Institutes of Health (RO1 CA055069, R35 CA053890, RO1 CA080205, RO1 CA098497, and RO1 CA144034).

Publisher Copyright:
© The European Society of Cardiology 2013.


  • Cardiovascular diseases
  • Chinese
  • epidemiology
  • fatty acids
  • mortality
  • nutrition


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