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The health concerns of methylmercury (MeHg) contamination of seafood have recently been extended to include cardiovascular effects, especially premature mortality. Although the fatty acids (fish oils) found in most species are thought to confer a wide range of health benefits, especially to the cardiovascular system, some epidemiological studies have suggested that such benefits may be offset by adverse effects of MeHg. This comprehensive review is based on searches of the NIH MEDLINE database and compares and contrasts 145 published studies involving cardiovascular effects and exposures to mercury and other fish contaminants, intake of fatty acids including dietary supplements of fish oils, and rates of seafood consumption. Since few of these studies include adequate simultaneous measurements of all of these potential predictor variables, we summarized their effects separately, across the available studies of each, and then drew conclusions based on the aggregated findings. It is important to realize that studies of seafood consumption encompass the net effects of all of these predictor variables, but that seafood intake studies are rarely supported by human biomarker measurements that reflect the actual uptake of harmful as well as beneficial fish ingredients. As a result, exposure measurement error is an issue when comparing studies and predictor variables. It is also possible that the observed benefits of eating fish may relate more to the characteristics of the consumers than to those of the fish. We found the evidence for adverse cardiovascular effects of MeHg to be sparse and unconvincing. Studies of cardiovascular mortality show net benefits, and the findings of adverse effects are mainly limited to studies Finland at high mercury exposure levels. By contrast, a very consistent picture of beneficial effects is seen for fatty acids, after recognizing the effects of exposure uncertainties and the presence of threshold effects. Studies based on measured biomarker levels are seen to be the most reliable and present a convincing picture of strong beneficial effects, especially for those causes of death involving cardiac arrhythmia. This conclusion also extends to studies of fish-oil supplementation. Studies based on fish consumption show mainly benefits from increased consumption. This finding is supported by an ecological study at the national population level, for which the lifestyle effects that might be correlated with fish consumption within a given population would be expected to ''average out'' across nations. Finally, the net survival benefits resulting from eating fish are consistent with studies involving complete diets, although benefits are also seen to accrue from reduced consumption of red meat and saturated fats

THE COMPETITION BETWEEN METHYLMERCURY RISKS AND OMEGA-3 POLYUNSATURATED FATTY ACID BENEFITS: A REVIEW OF CONFLICTING EVIDENCE ON FISH CONSUMPTION AND CARDIOVASCULAR HEALTH.