Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study
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Published:2016-01-13
Issue:1
Volume:5
Page:
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ISSN:2047-9980
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Container-title:Journal of the American Heart Association
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language:en
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Short-container-title:JAHA
Author:
Sala‐Vila Aleix12, Guasch‐Ferré Marta3, Hu Frank B.4, Sánchez‐Tainta Ana5, Bulló Mònica3, Serra‐Mir Mercè2, López‐Sabater Carmen6, Sorlí Jose V.7, Arós Fernando8, Fiol Miquel9, Muñoz Miguel A.10, Serra‐Majem Luis11, Martínez J. Alfredo12, Corella Dolores7, Fitó Montserrat10, Salas‐Salvadó Jordi3, Martínez‐González Miguel A.5, Estruch Ramón13, Ros Emilio2, Pérez‐Heras A., Viñas C., Casas R., de Santamaría L., Romero S., Sacanella E., Chiva G., Valderas P., Arranz S., Baena J.M., García M., Oller M., Amat J., Duaso I., García Y., Iglesias C., Simón C., Quinzavos Ll., Parra Ll., Liroz M., Benavent J., Clos J., Pla I., Amorós M., Bonet M.T., Martin M.T., Sánchez M.S., Altirriba J., Manzano E., Altés A., Cofán M., Valls‐Pedret C., Doménech M., Gilabert R., Bargalló N., González R., Molina C., Márquez F., Babio N., Sorli M., García Roselló J., Diaz‐López A A., Martin F., Tort R., Isach A., Costa B., Cabré J.J., Fernández‐Ballart J., Ibarrola‐Jurado N., Alegret C., Martínez P., Millán S., Piñol J.L., Basora T., Hernández J.M., Toledo E., Buil‐Cosiales P., Ruiz‐Canela M., Sanjulián B., Díez‐Espino J., Extremera‐Urabayen V., García‐Arellano A., Zazpe I., Basterra‐Gortari F.J., Goñi E, Razquin C., Serrano‐Martínez M., Bes‐Rastrollo M., Gea A., Martínez‐Lapiscina E.H., Nuñez‐Córdoba J.M., Arroyo‐Azpa C., García‐Pérez L., Villanueva‐Tellería J., Cortés‐Ugalde F., Sagredo‐Arce T., García de la Noceda‐Montoy Mª D., Vigata‐López Mª D., Arceiz‐Campo Mª T., Urtasun‐Samper A., Gueto‐Rubio Mª V., Churio‐Beraza B., Lamuela‐Raventós Rosa M., Castellote‐Bargallo A.I., Medina‐Remón A., Tresserra‐Rimbau A., Carrasco P., Ortega‐ Azorín C., Asensio E.M., Osma R., Barragán R., Francés F., Guillén M., González J.I., Saiz C., Portolés O., Giménez F.J., Coltell O., Guillem‐Saiz P., Quiles L., Pascual V., Riera C., Pages M.A., Godoy D., Carratalá‐Calvo A., Martín‐Rillo M.J., Llopis‐Osorio E., Ruiz‐ Baixauli J., Bertolín‐Muñoz A., Salaverría I., del Hierro T., Algorta J., Francisco S., Alonso A., San Vicente J., Sanz E., Felipe I., Alonso Gómez A., Loma‐Osorio A., García‐Valdueza M., Moñino M., Proenza A., Prieto R., Frontera G., Ginard M., Fiol F., Jover A., García J., Covas M.I., Tello S., Vila J., Schröder H., De la Torre R, Muñoz‐Aguayo D., Elosúa R., Marrugat J., Ferrer M., Álvarez‐Pérez J., DíazBenítez E., Bautista‐Castaño I., Maldonado‐Díaz I., Sánchez‐Villegas A., Castro I., Henríquez P., Ruano C., Ortiz A. P., Sarmiendo de la Fe F, Simón‐García C., Falcón‐Sanabria I., Macías‐Gutiérrez B., Santana‐Santana A.J., Gomez‐Gracia E., Fernández‐Crehuet J., Benítez Pont R., Bianchi Alba M., Wärnberg J., Gómez‐Huelgas R., Martínez‐González J., Velasco García V., de Diego Salas J, Baca Osorio A., Gil Zarzosa J., Sánchez Luque J.J., Vargas López E., Ruiz‐Gutierrez V., Jurado Ruiz E., Montero Romero E., García García M., Lapetra J., Leal M., Martínez E., Santos J.M., Ortega‐Calvo M., Román P., José García F., Iglesias P., Corchado Y., Mayoral E., Lama C., Pintó X., de la Cruz E, Galera A., Soler Y., Trias F., Sarasa I., Padres E., Figueras R., Solanich X., Pujol R., Corbella E., Cabezas C., Vinyoles E., Rovira M.A., García L., Flores G., Verdú J.M., Baby P., Ramos A., Mengual L., Roura P., Yuste M.C., Guarner A., Rovira A., Santamaría M.I., Mata M., de Juan C., Brau A., Marti A., Mitjavila M.T., Portillo M.P., Sáez G., Tur J.,
Affiliation:
1. Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain 2. Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain 3. Human Nutrition Unit, Biochemistry Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, and Hospital Universitari de Sant Joan de Reus, IISPV, Reus, Spain 4. Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA 5. Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain 6. Department of Nutrition and Food Science, School of Pharmacy, XaRTA, INSA, University of Barcelona, Spain 7. Department of Preventive Medicine, University of Valencia, Spain 8. Department of Cardiology, University Hospital of Alava, Vitoria, Spain 9. Institute of Health Sciences, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain 10. Cardiovascular Risk and Nutrition Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain 11. Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain 12. Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain 13. Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain
Abstract
Background
Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (
ALA
), a plant‐derived ω‐3 fatty acid. It is unclear whether
ALA
is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary
ALA
(0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day).
Methods and Results
We longitudinally evaluated 7202 participants in the
PRE
vención con
DI
eta
MED
iterránea (
PREDIMED
) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios.
ALA
intake correlated to walnut consumption (
r
=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting
ALA
recommendation (n=1615, 22.4%) were 0.72 (95%
CI
0.56–0.92) for all‐cause mortality and 0.95 (95%
CI
0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95%
CI
0.67–1.05) for all‐cause mortality, 0.61 (95%
CI
0.39–0.96) for fatal cardiovascular disease, 0.54 (95%
CI
0.29–0.99) for fatal coronary heart disease, and 0.49 (95%
CI
0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95%
CI
0.45–0.87]).
Conclusions
In participants without prior cardiovascular disease and high fish consumption, dietary
ALA
, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids.
Clinical Trial Registration
URL
:
http://www.Controlled-trials.com/
. Unique identifier:
ISRCTN
35739639.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
70 articles.
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