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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.

Sala-Vila A, Guasch-Ferré M, Hu FB, Sánchez-Tainta A, Bulló M, Serra-Mir M, López-Sabater C, Sorlí JV, Arós F, Fiol M, Muñoz MA, Serra-Majem L, Martínez JA, Corella D, Fitó M, Salas-Salvadó J, Martínez-González MA, Estruch R, Ros E; PREDIMED Investigators, 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 L, Parra L, 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 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 AI, Medina-Remón A, Tresserra-Rimbau A, Carrasco P, Ortega-Azorín C, Asensio EM, 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 MA, 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 MI, 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 AP, 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 JJ, 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 MA, García L, Flores G, Verdú JM, Baby P, Ramos A, Mengual L, Roura P, Yuste MC, Guarner A, Rovira A, Santamaría MI, Mata M, de Juan C, Brau A, Marti A, Mitjavila MT, Portillo MP, Sáez G, Tur J.

Erratum in
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. [J Am Heart Assoc. 2016]

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.
© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

KEYWORDS:
fatty acid; nutrition; sudden cardiac death
PMID: 26813890 [PubMed - in process]

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