Associations between the consumption of different kinds of seafood and out-of-hospital cardiac arrests of cardiac origin in Japan ☆ , ☆☆ Yasunori Suematsu a,1 , Shin-ichiro Miura a,b,1 , Bo Zhang b,c,1 , Yoshinari Uehara a,b,1 , Masaki Tokunaga a , Naohiro Yonemoto d , Hiroshi Nonogi e , Ken Nagao f , Takeshi Kimura g , Keijiro Saku a,b, ⁎ ,1 , On behalf of the Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group a Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan b The AIG Collaborative Research Institute of Cardiovascular Medicine, Fukuoka University, 814-0180, Japan c Department of Biochemistry, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan d Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan e Hospital Deputy, Shizuoka General Hospital, Shizuoka 420-8527, Japan f Department of Cardiology, Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, Nihon University School of Medicine, Tokyo 101-8309, Japan g Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan abstract article info Article history: Received 31 October 2013 Accepted 1 November 2013 Available online 14 November 2013 Keywords: Cardiac arrest Ecological study Fatty acids Seafood consumption Background: Prospective cohort studies have shown that seafood consumption is inversely related to fatal coro- nary heart disease, sudden cardiac death and stroke. We studied whether the kind of seafood consumed in addi- tion to seafood consumption per se is associated with out-of-hospital cardiac arrests (OHCA) of cardiac origin. Methods and results: We compared the average consumption of different kinds of seafood and other risk factors to the average incidence of age-adjusted OHCA (660,672 cases of OHCA: 55.2% of cardiac origin and 44.8% of non- cardiac origin) between 2005 and 2010 in the 47 prefectures of Japan. There were many significant correlations between the incidence of age-adjusted OHCA of cardiac origin (ad-OHCA-CO) and the consumption of many kinds of seafood, but not the total consumption of seafood. The consumption of horse mackerel (r = -0.568, p b 0.0001) and saury (r = 0.607, p b 0.0001) showed the highest negative and positive correlations, respec- tively, with the age-adjusted incidence of ad-OHCA-CO. Conclusions: In Japan, the consumption of different kinds of seafood may be an important factor in OHCA of cardiac origin. Thus, dietary habits with regard to seafood may play a role in OHCA of cardiac origin, however, the question of whether to eat fish in general or instead to eat certain kinds of fish is still unclear. © 2013 The Authors. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction Dietary prevention for cardiovascular diseases (CVD) originated in animal studies in which the high intake of dietary cholesterol was shown to lead to hypercholesterolemia and promote atherosclerosis. However, dietary intervention trials in humans that have targeted the primary and secondary prevention of CVD have not always been suc- cessful [1–3], since the trials were too small or too short, or the interven- tion itself was too weak to produce changes in lifestyle or diet [4]. However, epidemiological surveys have shown a lower prevalence of CVD in populations around the Mediterranean, where the diet is rich in olive oil, fiber and n-3 polyunsaturated fatty acids (n-3PUFAs), and in Asia (e.g., Japan), where the diet has traditionally been low in fat and high in carbohydrates with high levels of fish consumption [5–7]. Prospective cohort studies have shown that the consumption of seafood and fish oil is inversely related to fatal coronary heart disease [8,9], sud- den cardiac death (SCD) [10,11] and stroke [10,12,13], and most of the reduction in SCD could be explained by the antiarrhythmic effects of n-3PUFAs in fish [14,15]. As a result, current guidelines for both the primary and secondary prevention of cardiovascular events [15–17], including Japanese guidelines [18,19], encourage the consumption of fresh seafood or oily fish at least twice a week. In January 2005, the Fire and Disaster Management Agency (FDMA) of Japan launched a prospective, nationwide, population-based, cohort study in subjects who had had an out-of-hospital cardiac arrest (OHCA) to evaluate the effect of the nationwide dissemination of public-access AEDs on the rate of survival among patients who had an OHCA [20–25], and the Japanese Circulation Society (JCS) Resuscitation Science Study (JCS-ReSS) Group had a suitable database. Therefore, as a IJC Heart & Vessels 2 (2014) 8–14 ☆ This work was supported by a grant-in-aid from the AIG Collaborative Research Institute of Cardiovascular Medicine (2011–2013), Fukuoka University 814-0180, Japan, the Baccalaureate Degree Program “Learning that Life is Precious” of Fukuoka University (2011–2013), and the JCS-ReSS group of the Japanese Circulation Society. ☆☆ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivative Works License, which permits non-commer- cial use, distribution, and reproduction in any medium, provided the original author and source are credited. ⁎ Corresponding author at: Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma Jonan-ku, Fukuoka 814-0180, Japan. E-mail address: saku-k@fukuoka-u.ac.jp (K. Saku). 1 YS, SM, BZ, YU and KS contributed equally to this work. 2214-7632/$ – see front matter © 2013 The Authors. Published by Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijchv.2013.11.002 Contents lists available at ScienceDirect IJC Heart & Vessels journal homepage: http://www.journals.elsevier.com/ijc-heart-and-vessels