*Review* **Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies**

**Lan Jiang, Jinyu Wang, Ke Xiong, Lei Xu, Bo Zhang and Aiguo Ma \***

Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; jiangl59@163.com (L.J.); wangjinyu@qdu.edu.cn (J.W.); kexiong@qdu.edu.cn (K.X.); xulei951121@163.com (L.X.); zhangzhang19940516@163.com (B.Z.)

**\*** Correspondence: magfood@qdu.edu.cn

**Abstract:** Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85−0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85–0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94–0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94–0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.

**Keywords:** fish; n-3 polyunsaturated fatty acid; cardiovascular disease mortality; meta-analysis; prospective cohort studies
