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ω-3 Polyunsaturated fatty acid biomarkers and coronary heart disease : Pooling project of 19 cohort studies

Del Gobbo, Liana C.; Imamura, Fumiaki; Aslibekyan, Stella; Marklund, Matti; Virtanen, Jyrki K.; Wennberg, Maria; Yakoob, Mohammad Y.; Chiuve, Stephanie E.; Dela Cruz, Luicito and Frazier-Wood, Alexis C., et al. (2016) In JAMA Internal Medicine 176(8). p.1155-1166
Abstract

Importance: The role of ω-3 polyunsaturated fatty acids for primary prevention of coronary heart disease (CHD) remains controversial. Most prior longitudinal studies evaluated self-reported consumption rather than biomarkers. Objective: To evaluate biomarkers of seafood-derived eicosapentaenoic acid (EPA; 20:5 ω-3), docosapentaenoic acid (DPA; 22:5 ω-3), and docosahexaenoic acid (DHA; 22:6 ω-3) and plant-derived α-linolenic acid (ALA; 18:3 ω-3) for incident CHD. Data Sources: A global consortium of 19 studies identified by November 2014. Study Selection: Available prospective (cohort, nested case-control) or retrospective studies with circulating or tissue ω-3 biomarkers and ascertained CHD. Data Extraction and Synthesis: Each study... (More)

Importance: The role of ω-3 polyunsaturated fatty acids for primary prevention of coronary heart disease (CHD) remains controversial. Most prior longitudinal studies evaluated self-reported consumption rather than biomarkers. Objective: To evaluate biomarkers of seafood-derived eicosapentaenoic acid (EPA; 20:5 ω-3), docosapentaenoic acid (DPA; 22:5 ω-3), and docosahexaenoic acid (DHA; 22:6 ω-3) and plant-derived α-linolenic acid (ALA; 18:3 ω-3) for incident CHD. Data Sources: A global consortium of 19 studies identified by November 2014. Study Selection: Available prospective (cohort, nested case-control) or retrospective studies with circulating or tissue ω-3 biomarkers and ascertained CHD. Data Extraction and Synthesis: Each study conducted standardized, individual-level analysis using harmonized models, exposures, outcomes, and covariates. Findings were centrally pooled using random-effects meta-analysis. Heterogeneity was examined by age, sex, race, diabetes, statins, aspirin, ω-6 levels, and FADS desaturase genes. Main Outcomes and Measures: Incident total CHD, fatal CHD, and nonfatal myocardial infarction (MI). Results: The 19 studies comprised 16 countries, 45 637 unique individuals, and 7973 total CHD, 2781 fatal CHD, and 7157 nonfatal MI events, with ω-3 measures in total plasma, phospholipids, cholesterol esters, and adipose tissue. Median age at baselinewas 59 years (range, 18-97 years), and 28 660 (62.8%)were male. In continuous (per 1-SD increase) multivariable-adjusted analyses, the ω-3 biomarkers ALA, DPA, and DHAwere associated with a lower risk of fatal CHD, with relative risks (RRs) of 0.91 (95%CI, 0.84-0.98) for ALA, 0.90 (95%CI, 0.85-0.96) for DPA, and 0.90 (95%CI, 0.84-0.96) for DHA. Although DPA was associated with a lower risk of total CHD (RR, 0.94; 95%CI, 0.90-0.99), ALA (RR, 1.00; 95%CI, 0.95-1.05), EPA (RR, 0.94; 95%CI, 0.87-1.02), and DHA (RR, 0.95; 95%CI, 0.91-1.00)were not. Significant associations with nonfatal MIwere not evident. Associations appeared generally stronger in phospholipids and total plasma. Restricted cubic splines did not identify evidence of nonlinearity in dose responses. Conclusions and Relevance: On the basis of available studies of free-living populations globally, biomarker concentrations of seafood and plant-derived ω-3 fatty acids are associated with a modestly lower incidence of fatal CHD.

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JAMA Internal Medicine
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176
issue
8
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12 pages
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American Medical Association
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  • Scopus:84980320220
ISSN
2168-6106
DOI
10.1001/jamainternmed.2016.2925
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English
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ab9753f3-d893-49fd-b866-6b4f3dbd2dfe
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2016-08-29 13:22:08
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2016-12-04 04:53:37
@misc{ab9753f3-d893-49fd-b866-6b4f3dbd2dfe,
  abstract     = {<p>Importance: The role of ω-3 polyunsaturated fatty acids for primary prevention of coronary heart disease (CHD) remains controversial. Most prior longitudinal studies evaluated self-reported consumption rather than biomarkers. Objective: To evaluate biomarkers of seafood-derived eicosapentaenoic acid (EPA; 20:5 ω-3), docosapentaenoic acid (DPA; 22:5 ω-3), and docosahexaenoic acid (DHA; 22:6 ω-3) and plant-derived α-linolenic acid (ALA; 18:3 ω-3) for incident CHD. Data Sources: A global consortium of 19 studies identified by November 2014. Study Selection: Available prospective (cohort, nested case-control) or retrospective studies with circulating or tissue ω-3 biomarkers and ascertained CHD. Data Extraction and Synthesis: Each study conducted standardized, individual-level analysis using harmonized models, exposures, outcomes, and covariates. Findings were centrally pooled using random-effects meta-analysis. Heterogeneity was examined by age, sex, race, diabetes, statins, aspirin, ω-6 levels, and FADS desaturase genes. Main Outcomes and Measures: Incident total CHD, fatal CHD, and nonfatal myocardial infarction (MI). Results: The 19 studies comprised 16 countries, 45 637 unique individuals, and 7973 total CHD, 2781 fatal CHD, and 7157 nonfatal MI events, with ω-3 measures in total plasma, phospholipids, cholesterol esters, and adipose tissue. Median age at baselinewas 59 years (range, 18-97 years), and 28 660 (62.8%)were male. In continuous (per 1-SD increase) multivariable-adjusted analyses, the ω-3 biomarkers ALA, DPA, and DHAwere associated with a lower risk of fatal CHD, with relative risks (RRs) of 0.91 (95%CI, 0.84-0.98) for ALA, 0.90 (95%CI, 0.85-0.96) for DPA, and 0.90 (95%CI, 0.84-0.96) for DHA. Although DPA was associated with a lower risk of total CHD (RR, 0.94; 95%CI, 0.90-0.99), ALA (RR, 1.00; 95%CI, 0.95-1.05), EPA (RR, 0.94; 95%CI, 0.87-1.02), and DHA (RR, 0.95; 95%CI, 0.91-1.00)were not. Significant associations with nonfatal MIwere not evident. Associations appeared generally stronger in phospholipids and total plasma. Restricted cubic splines did not identify evidence of nonlinearity in dose responses. Conclusions and Relevance: On the basis of available studies of free-living populations globally, biomarker concentrations of seafood and plant-derived ω-3 fatty acids are associated with a modestly lower incidence of fatal CHD.</p>},
  author       = {Del Gobbo, Liana C. and Imamura, Fumiaki and Aslibekyan, Stella and Marklund, Matti and Virtanen, Jyrki K. and Wennberg, Maria and Yakoob, Mohammad Y. and Chiuve, Stephanie E. and Dela Cruz, Luicito and Frazier-Wood, Alexis C. and Fretts, Amanda M. and Guallar, Eliseo and Matsumoto, Chisa and Prem, Kiesha and Tanaka, Tosh and Wu, Jason H Y and Zhou, Xia and Helmer, Catherine and Ingelsson, Erik and Yuan, Jian Min and Barberger-Gateau, Pascale and Campos, Hannia and Chaves, Paulo H M and Djoussé, Luc and Giles, Graham G. and Gómez-Aracena, Jose and Hodge, Allison M. and Hu, Frank B. and Jansson, Jan Håkan and Johansson, Ingegerd and Khaw, Kay Tee and Koh, Woon Puay and Lemaitre, Rozenn N. and Lind, Lars and Luben, Robert N. and Rimm, Eric B. and Risérus, Ulf and Samieri, Cecilia and Franks, Paul W. and Siscovick, David S. and Stampfer, Meir and Steffen, Lyn M. and Steffen, Brian T. and Tsai, Michael Y. and Van Dam, Rob M. and Voutilainen, Sari and Willett, Walter C. and Woodward, Mark and Mozaffarian, Dariush},
  issn         = {2168-6106},
  language     = {eng},
  month        = {08},
  number       = {8},
  pages        = {1155--1166},
  publisher    = {ARRAY(0x7e2b3d0)},
  series       = {JAMA Internal Medicine},
  title        = {ω-3 Polyunsaturated fatty acid biomarkers and coronary heart disease : Pooling project of 19 cohort studies},
  url          = {http://dx.doi.org/10.1001/jamainternmed.2016.2925},
  volume       = {176},
  year         = {2016},
}