N6 and N3 Fatty Acid Cholesteryl Esters in Relation to Fatal CHD in a Dutch Adult Population: A Nested Case Control Study and Meta Analysis

January 1, 2013 Human Health and Nutrition Data 0 Comments

N6 and N3 Fatty Acid Cholesteryl Esters in Relation to Fatal CHD in a Dutch Adult Population: A Nested Case Control Study and Meta Analysis

Year: 2013
Authors: Goede, J. Verschuren, W.M. Boer, J.M. Verberne, L.D. Kromhout, D. Geleijnse, J.M.
Publication Name: PLoS One
Publication Details: Volume 8; Issue 5; Page e59408


Background: Dietary polyunsaturated fatty acids (PUFA) are inversely related to coronary heart disease (CHD) in epidemiological studies. We examined the associations of plasma n6 and n3 PUFA in cholesteryl esters with fatal CHD in a nested case-control study. Additionally, we performed a dose response meta analysis of similar prospective studies on cholesteryl ester PUFA. Methods: We used data from two population based cohort studies in Dutch adults aged 20 to 65y. Blood and data collection took place from 1987 to 1997 and subjects were followed for 8 to 19y. We identified 279 incident cases of fatal CHD and randomly selected 279 controls, matched on age, gender, and enrollment date. Odds ratios (OR) were calculated per standard deviation (SD) increase of cholesteryl ester PUFA. Results: After adjustment for confounders, the OR (95 percent CI) for fatal CHD per SD increase in plasma linoleic acid was 0.89
(0.74 to 1.06). Additional adjustment for plasma total cholesterol and systolic blood pressure attenuated this association (OR:0.95; 95 percent CI: 0.78 to 1.15). Arachidonic acid was not associated with fatal CHD (OR per SD:1.11; 95 percent CI: 0.92 to 1.35). The ORs (95 percent CI) for fatal CHD for an SD increase in n3 PUFA were 0.92 (0.74 to 1.15) for alpha linolenic acid and 1.06 (0.88 to 1.27) for EPA and DHA. In the meta analysis, a 5 percent higher linoleic acid level was associated with a 9 percent lower risk (relative risk: 0.91; 95 percent CI: 0.84 to 0.98) of CHD. The other fatty acids were not associated with CHD. Conclusion: In this Dutch population, n 6 and n3 PUFA in cholesteryl esters were not significantly related to fatal CHD. Our data, together with findings from previous prospective studies, support that linoleic acid in plasma cholesteryl is inversely associated with CHD. (Authors abstract)
Several reviews of prospective cohort studies and randomized trials suggest that the intake of n  6 and n  3 polyunsaturated fatty acids (PUFA) protect against coronary heart disease (CHD). Biomarkers of dietary intake are widely used in epidemiological studies. Fatty acids can be measured as free fatty acids in serum (or plasma), as components of triglycerides, phospholipids, cholesteryl esters, erythrocyte membranes, platelets, or in adipose tissue from various sites. Cholesteryl esters are found in plasma lipoproteins and reflect dietary intake of PUFA during the previous weeks. This study investigated the associations of n  6 and n  3 PUFA, measured in plasma cholesteryl esters with the risk of fatal CHD in a prospective case control study of Dutch adults, adjusted for confounders. Additionally, we performed a meta analysis of nested case-control and cohort studies on plasma PUFA measured in cholesteryl esters in relation to CHD.
In a nested case control study in Dutch adultse, the study did not observe statistically significant associations between plasma cholesteryl ester linoleic acid levels and fatal CHD. When the data was pooled with those from similar prospective studies in a meta analysis, a 5 per cent higher linoleic acid level was related to a significant 9 per cent lower CHD risk. Arachidonic acid and the n  3 PUFA alpha linolenic acid, EPA, and DHA were not associated with CHD risk in the present study and in the meta analysis. A 5 per cent higher linoleic acid level was related to a significant 9 per cent lower CHD risk in a meta analysis. Plasma arachidonic acid did not predict CHD in this nested case-control study and meta analysis. In this nested case control study and meta-analysis, no association of cholesteryl ester alpha linolenic acid or EPA  and DHA with CHD was noted. In conclusion, the findings in combination with those from other prospective studies support an inverse association between linoleic acid in plasma cholesteryl esters and CHD risk. For plasma cholesteryl ester levels of n  3 PUFA, however, no relations with CHD risk were found in this prospective study and meta analysis, which raises concern regarding the validity of these biomarkers of intake for epidemiological studies.

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