Based on PubMed | Does eating fish reduce the risk of heart disease?

Eating fish appears to be associated with a lower risk of heart disease, especially fatal events like sudden cardiac death, when eaten regularly as part of a balanced diet. ^[1] Eating fish rich in omega‑3 fats at least twice a week is generally linked with heart benefits such as lower triglycerides, slightly lower blood pressure, and reduced risk of dangerous heart rhythms. ^{[2] [3]}

What the evidence suggests

• Observational studies (following large groups over time) consistently suggest that people who eat fish about once a week have a lower risk of dying from coronary heart disease (CHD), with reductions around 16% for fatal CHD and lower risk of sudden cardiac death. ^{[4] [5]}
• Dose‑response data in populations with low fish intake show that higher intake of marine omega‑3s (EPA+DHA) and fish is linked to lower risk of fatal CHD and fatal heart attacks, while nonfatal heart attacks may not be reduced. ^{[6] [7]}
• Randomized trials of omega‑3 supplements (pills) in people already receiving modern heart medications have shown mixed or small effects on hard outcomes, suggesting that eating fish itself as a whole food may provide broader benefits than supplements alone. ^{[4] [5]}

How fish may help the heart

• Omega‑3 fatty acids (EPA and DHA) in fish are a type of unsaturated fat that may reduce inflammation, support blood vessel health, and influence heart rhythm. ^[8]
• Regular fish intake is associated with lower blood triglycerides, small reductions in blood pressure, and a lower risk of abnormal heartbeats, all of which can support heart health. ^[2]

How much and what kind of fish

• A practical target is two servings per week of fish, especially fatty (oily) fish rich in omega‑3s; a serving is about 4 ounces (113 g), roughly the size of a deck of cards. ^{[1] [9]}
• Fatty fish with higher omega‑3 content include salmon, sardines, Atlantic mackerel, herring, lake trout, and canned light tuna. ^[10]

Fish vs. supplements

• Eating fish seems to provide more consistent heart benefits than taking omega‑3 supplements alone for most people, possibly because fish delivers nutrients beyond omega‑3s and replaces less healthy proteins. ^[11]
• In trials where participants already take evidence‑based heart medications, adding omega‑3 capsules has not always reduced events like sudden cardiac death, indicating benefits may depend on context and baseline risk. ^{[4] [5]}

Safety and mercury considerations

• For most adults, the benefits of eating fish as part of a healthy diet generally outweigh the potential risks from contaminants. ^[8]
• Choosing a variety of low‑mercury fish like salmon and shrimp helps keep mercury exposure low while still providing omega‑3s. ^[12]
• Farmed vs. wild: contaminant levels in farmed fish are not considered harmful at typical intake levels, so either can be part of a heart‑healthy diet. ^[11]

Practical tips for heart‑healthy fish intake

• Aim for two fish meals per week, focusing on fatty fish. ^[1]
• Cook by baking, broiling, roasting, steaming, boiling, or microwaving rather than deep‑frying to keep the meal heart‑friendly. ^[13]
• If you don’t like fish, consider other omega‑3 sources such as flaxseed or flaxseed oil, though these contain ALA (a different omega‑3) and may not produce the same effects as marine omega‑3s. ^[11]

Bottom line

• Regular fish consumption especially oily fish twice weekly is associated with a lower risk of fatal heart disease and sudden cardiac death, with supportive biological mechanisms like triglyceride lowering and anti‑arrhythmic effects. ^{[1] [4]}
• While supplement trials show mixed results in heavily medicated populations, the overall balance of evidence supports including fish in a heart‑healthy diet for most adults. ^{[4] [5] [8]}