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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

2016; Wiley; Volume: 5; Issue: 1 Linguagem: Inglês

10.1161/jaha.115.002543

2047-9980

Aleix Sala‐Vila, Marta Guasch‐Ferré, Frank B. Hu, Ana Sánchez‐Tainta, Mònica Bulló, Mercè Serra‐Mir, M. Carmen López‐Sabater, José V. Sorlí, Fernando Arós, Miquel Fiol, Miguel Ángel Muñoz, Luís Serra‐Majem, J. Alfredo Martínéz, Dolores Corella, Montserrat Fitó, Jordi Salas‐Salvadó, Miguel Ángel Martínez‐González, Ramón Estruch, Emilio Ros, Ana Pérez-Heras, Carles Viñas, Rosa Casas, Luigi Santa-Maria, Sonia Lidia Romero Vela, Emilio Sacanella, G. Chiva, Patricio Valderas, Sara Arranz, Jacinto Baena, Montse García, M. Oller, Jordi Delás, I. Duaso, Y. García, Carmen Iglésias, C. Simón, Ll. Quinzavos, L. Parra, M. Liroz, Jaume Benavent, J. Clos, Indira Plá, M. Amorós, Mercedes Bonet, Mariela Martín, María S. Guillem, J. Altirriba, E. Manzano, A. Altés, Montserrat Cofán, Cinta Valls‐Pedret, Mónica Doménech, Rosa Gilabert, Núria Bargalló, R. González, C. Molina, Francisco Carlos López-Márquez, Nancy Babió, M.L. Sorli, J Roselló, A. Diaz‐López A, Francisco Martín‐Luján, R. Tort, A. Isach, B Costa, Joan Vila, Joan Fernández‐Ballart, Núria Ibarrola-Jurado, C. Alegret, Pablo Pérez‐Martínez, Sandra Millán, Josep Lluís Piñol, Teresa Basora, José M. de la Torre Hernández, Estefanía Toledo, Pilar Buil‐Cosiales, Miguel Ruiz‐Canela, B. Sanjulián, Javier Díez‐Espino, V. Extremera‐Urabayen, Ana García‐Arellano, Itzíar Zazpe, Francisco Javier Basterra-Gortari, E. Goñi, Cristina Razquín, Manuel Serrano-Martínez, Maira Bes‐Rastrollo, Alfredo Gea, Elena H. Martínez‐Lapiscina, Jorge M. Núñez‐Córdoba, C. Arroyo‐Azpa, Luis‐Emilio García‐Pérez, J. Villanueva‐Tellería, F. Cortés‐Ugalde, T. Sagredo‐Arce, Ma D. García de la Noceda‐Montoy, Ma D. Vigata‐López, Ma T. Arceiz‐Campo, A. Urtasun‐Samper, M. V. Güeto-Rubio, B. Churio‐Beraza, Rosa M. Lamuela‐Raventós, A.I. Castellote-Bargalló, Alexander Medina‐Remón, Anna Tresserra‐Rimbau, Paula Carrasco, Carolina Ortega Azorín, Eva M. Asensio, R. Osma, Rocío Barragán, F. Francés, Marisa Guillén, José I. González, Carmen Sáiz, Olga Portolés, F.J. Giménez, Óscar Coltell, Patricia Guillem‐Sáiz, Laura Quiles, Vicente Pascual, Cristina Riera, M Pagès, Daniela Godoy, Arturo Carratalá, M. J. Martín‐Rillo, E. Llopis‐Osorio, J. Ruiz‐ Baixauli, A. Bertolín‐Muñoz, Itziar Salaverria‐Lete, T. del Hierro, Jaime Algorta, Saionara Cristina Francisco, Álvaro Alonso, J. San Vicente, E. Sanz, Isabelly Cristina Felipe, Ángel Gómez, A Loma-Osorio, M. García‐Valdueza, Manuel Moñino, Ana M. Proenza, Rafael Prieto, G. Frontera, M. Ginard, Francisca Fiol, A. Jover, Julio Bobes, María Isabel Covas, Susana Tello, Joan Vila, Helmut Schröder, Rafael de la Torre, Daniel Muñoz‐Aguayo, Roberto Elosúa, Jaume Marrugat, Montse Ferrer, Jacqueline Álvarez-Pérez, Elena María Díaz-Benítez, Inmaculada Bautista-Castaño, I. Maldonado‐Díaz, Almudena Sánchez‐Villegas, Isabela Coelho, P Henríquez, C. Ruano, Ana P. Ortíz, Farber Fe, Concepción Simón-García, Ismael Falcón-Sanabria, Bernardo Macías-Gutiérrez, Ángel Julio Santana-Santana, Enrique Gómez‐Gracia, Joaquín Fernández-Crehuet Navajas, R. Benítez Pont, Maria Alba, Julia Wärnberǵ, Ricardo Gómez‐Huelgas, Javier Martínez, Vanessa Garcia, J. de Diego Salas, Alvaro Osorio, J. Gil Zarzosa, J.J. Sánchez Luque, E. Vargas López, Valentina Ruiz‐Gutiérrez, E. Jurado Ruiz, E. Romero, M. García García, José Lapetra, Mariano Leal Hernández, E. Martínez, José Manuel Santos‐Lozano, Manuel Ortega‐Calvo, P. Román, Fernando García, Pablo A. Iglesias, Y. Corchado, E. Mayoral, Carolina Ponce de León De Lama, Xavier Pintó, Elizabeth De La Cruz, A. Galera, Y. Soler, F. Trias, I. Sarasa, E. Padres, R. Figueras, Xavier Solanich, Ramón Oliver Pujol, Emili Corbella, Carmen Cabezas, Ernest Vinyoles, M.A. Rovira, Lorena García, Gema Flores, José María Verdú-Rotellar, Poornima Baby, Ángel Mazón, Lourdes Mengual, Pere Roura‐Poch, María Concepción Ayuso Yuste, A. Guarner, Adela Rovira, Milton Santamaría, M. Mata, C. de Juan, Antonio Sanz Brau, Amelia Martí, M. T. Mitjavila, María P. Portillo, Guillermo T. Sáez, Josep A. Tur,

Diet, Metabolism, and Disease

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).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]).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.URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639.