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J Am Heart Assoc. 2016 Jan 26;5(1). pii: e002543. doi: 10.1161/JAHA.115.002543.

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.

Collaborators (212)

Pérez-Heras A, Viñas C, Casas R, de Santamaría L, Romero S, Sacanella E, Chiva G, Valderas P, Arranz S, Baena JM, 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 MT, Martin MT, Sánchez MS, 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, Martin F, Tort R, Isach A, Costa B, Cabré JJ, Fernández-Ballart J, Ibarrola-Jurado N, Alegret C, Martínez P, Millán S, Piñol JL, Basora T, Hernández JM, Toledo E, Buil-Cosiales P, Ruiz-Canela M, Sanjulián B, Díez-Espino J, Extremera-Urabayen V, García-Arellano A, Zazpe I, Basterra-Gortari FJ, Goñi E, Razquin C, Serrano-Martínez M, Bes-Rastrollo M, Gea A, Martínez-Lapiscina EH, Nuñez-Córdoba JM, Arroyo-Azpa C, García-Pérez L, Villanueva-Tellería J, Cortés-Ugalde F, Sagredo-Arce T, García de la Noceda-Montoy MD, Vigata-López MD, Arceiz-Campo MT, Urtasun-Samper A, Gueto-Rubio MV, Churio-Beraza B, Lamuela-Raventós RM, Castellote-Bargallo A, Medina-Remón A, Tresserra-Rimbau A, Carrasco P, Ortega-Azorín C, Asensio E, Osma R, Barragán R, Francés F, Guillén M, González JI, Saiz C, Portolés O, Giménez FJ, Coltell O, Guillem-Saiz P, Quiles L, Pascual V, Riera C, Pages M, Godoy D, Carratalá-Calvo A, Martín-Rillo MJ, 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, 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, Sarmiendo de la Fe F, Simón-García C, Falcón-Sanabria I, Macías-Gutiérrez B, Santana-Santana AJ, 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, Vargas López E, Ruiz-Gutierrez V, Jurado Ruiz E, Montero Romero E, García García M, Lapetra J, Leal M, Martínez E, Santos JM, 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, García L, Flores G, Verdú JM, Baby P, Ramos A, Mengual L, Roura P, Yuste M, Guarner A, Rovira A, Santamaría MI, Mata M, de Juan C, Brau A, Marti A, Mitjavila M, Portillo MP, Sáez G, Tur J.

Author information

1
Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain (A.S.V.) Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (A.S.V., M.S.M., E.R.).
2
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 (M.G.F., B., J.S.S.).
3
Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA (F.B.H.).
4
Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain (A.T., M.A.M.G.).
5
Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (A.S.V., M.S.M., E.R.).
6
Department of Nutrition and Food Science, School of Pharmacy, XaRTA, INSA, University of Barcelona, Spain (C.S.).
7
Department of Preventive Medicine, University of Valencia, Spain (J.V.S., D.C.).
8
Department of Cardiology, University Hospital of Alava, Vitoria, Spain (F.A.).
9
Institute of Health Sciences, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain (M.F.).
10
Cardiovascular Risk and Nutrition Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain (M.A.M., M.F.).
11
Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain (L.S.M.).
12
Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain (A.M.).
13
Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (R.E.).

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 PREvención con DIeta MEDiterránea (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: ISRCTN35739639.

KEYWORDS:

fatty acid; nutrition; sudden cardiac death

PMID:
26813890
PMCID:
PMC4859371
DOI:
10.1161/JAHA.115.002543
[Indexed for MEDLINE]
Free PMC Article

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