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Objective: To test whether change in the frequency of fish intake at population level would affect the trends of death from CHD and how many CHD events could be prevented in Hong Kong, a population among those with the highest fish consumption and the lowest CHD mortality in the world. Design: Time trends analysis with data from repeated dietary surveys and death registration. Setting: Hong Kong SAR, People's Republic of China. Subjects: A total of 3096 men and women aged 40-69 years who participated in territory-wide surveys in 1995 or 2003 were included in the analysis of changes in dietary fish intake; all adults aged 40-69 years in Hong Kong were included in the analysis of time trends of CHD mortality. Results: Over the period, the frequency of fish intake increased and CHD mortality decreased significantly in the population age group of 50-69 years, while in the age group of 40-49 years little change in both fish intake and CHD mortality was observed. It was estimated that 240 CHD deaths (or 29% of the total) were avoided among the population aged 40-69 years in 2003, as more than half of the population consumed fish every day in Hong Kong. Conclusions: The time trend of CHD mortality was inversely related to the trend of fish intake. The frequency of fish intake may have a substantial impact on the population for the prevention of CHD deaths in Hong Kong. [ABSTRACT FROM AUTHOR]