Plasma phospholipid fatty acid concentration and incident coronary heart disease in men and women: the EPIC-Norfolk prospective study

Kay-Tee Khaw, Marlin D Friesen, Elio Riboli, Robert Luben, Nicholas Wareham, Kay-Tee Khaw, Marlin D Friesen, Elio Riboli, Robert Luben, Nicholas Wareham

Abstract

Background: The lack of association found in several cohort studies between dietary saturated fat and coronary heart disease (CHD) risk has renewed debate over the link between dietary fats and CHD.

Methods and findings: We assessed the relationship between plasma phospholipid fatty acid (PFA) concentration and incident CHD using a nested case control design within a prospective study (EPIC-Norfolk) of 25,639 individuals aged 40-79 years examined in 1993-1997 and followed up to 2009. Plasma PFA concentrations were measured by gas chromatography in baseline samples retrieved from frozen storage. In 2,424 men and women with incident CHD compared with 4,930 controls alive and free of cardiovascular disease, mean follow-up 13 years, saturated PFA (14:0, 16:0,18:0) plasma concentrations were significantly associated with increased CHD risk (odds ratio [OR] 1.75, 95% CI 1.27-2.41, p<0.0001), in top compared to bottom quartiles (Q), and omega-6 polyunsaturated PFA concentrations were inversely related (OR 0.77, 0.60-0.99, p<0.05) after adjusting for age, sex, body mass index, blood pressure, smoking, alcohol intake, plasma vitamin C, social class, education, and other PFAs. Monounsaturated PFA, omega-3 PFA, and trans PFA concentrations were not significantly associated with CHD. Odd chain PFA (15:0, 17:0) concentrations were significantly inversely associated with CHD (OR 0.73, 0.59-0.91, p<0.001, Q4 versus Q1). Within families of saturated PFA or polyunsaturated PFA, significantly heterogeneous relationships with CHD were observed for individual fatty acids.

Conclusions: In this study, plasma concentrations of even chain saturated PFA were found to be positively and omega-6 polyunsaturated PFA inversely related to subsequent coronary heart disease risk. These findings are consistent with accumulating evidence suggesting a protective role of omega-6 fats substituting for saturated fats for CHD prevention.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Mozaffarian D, Aro A, Willett WC. Health effects of trans-fatty acids: experimental and observational evidence. Eur J Clin Nutr. 2009;63:S5–21.
    1. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91:535–546.
    1. Stamler J. Diet-heart: a problematic revisit. Am J Clin Nutr. 2010;91:497–499.
    1. Howard BV, Van Horn L, Hsia J, Manson JE, Stefanick ML, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295:655–666.
    1. de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343:1454–1459.
    1. Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010;7:e1000252. doi: .
    1. Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab. 2009;55:173–201.
    1. Cantwell MM. Assessment of individual fatty acid intake. Proc Nutr Soc. 2000;59:187–191.
    1. Hodson L, Skeaff CM, Fielding BA. Fatty acid composition of adipose tissue and blood in humans and its use as a biomarker of dietary intake. Prog Lipid Res. 2008;47:348–380.
    1. Poppitt SD, Kilmartin P, Butler P, Keogh GF. Assessment of erythrocyte phospholipid fatty acid composition as a biomarker for dietary MUFA, PUFA or saturated fatty acid intake in a controlled cross-over intervention trial. Lipids Health Dis. 2005;4:30.
    1. Saadatian-Elahi M, Slimani N, Chajes V, Jenab M, Goudable J, et al. Plasma phospholipid fatty acid profiles and their association with food intakes: results from a cross-sectional study within the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr. 2009;89:331–346.
    1. Wolk A, Furuheim M, Vessby B. Fatty acid composition of adipose tissue and serum lipids are valid biological markers of dairy fat intake in men. J Nutr. 2001;131:828–833.
    1. Zock PL, Mensink RP, Harryvan J, de Vries JH, Katan MB. Fatty acids in serum cholesteryl esters as quantitative biomarkers of dietary intake in humans. Am J Epidemiol. 1997;145:1114–1122.
    1. Clarke R, Shipley M, Armitage J, Collins R, Harris W. Plasma phospholipid fatty acids and CHD in older men: Whitehall study of London civil servants. Br J Nutr. 2009;102:279–284.
    1. Guallar E, Hennekens CH, Sacks FM, Willett WC, Stampfer MJ. A prospective study of plasma fish oil levels and incidence of myocardial infarction in U.S. male physicians. J Am Coll Cardiol. 1995;25:387–394.
    1. Laaksonen DE, Nyyssonen K, Niskanen L, Rissanen TH, Salonen JT. Prediction of cardiovascular mortality in middle-aged men by dietary and serum linoleic and polyunsaturated fatty acids. Arch Intern Med. 2005;165:193–199.
    1. Lemaitre RN, King IB, Mozaffarian D, Kuller LH, Tracy RP, et al. n-3 Polyunsaturated fatty acids, fatal ischemic heart disease, and nonfatal myocardial infarction in older adults: the Cardiovascular Health Study. Am J Clin Nutr. 2003;77:319–325.
    1. Ohrvall M, Berglund L, Salminen I, Lithell H, Aro A, et al. The serum cholesterol ester fatty acid composition but not the serum concentration of alpha tocopherol predicts the development of myocardial infarction in 50-year-old men: 19 years follow-up. Atherosclerosis. 1996;127:65–71.
    1. Simon JA, Hodgkins ML, Browner WS, Neuhaus JM, Bernert JT, Jr, et al. Serum fatty acids and the risk of coronary heart disease. Am J Epidemiol. 1995;142:469–476.
    1. Sun Q, Ma J, Campos H, Hu FB. Plasma and erythrocyte biomarkers of dairy fat intake and risk of ischemic heart disease. Am J Clin Nutr. 2007;86:929–937.
    1. Wang I, Folsom AR, Eckfeldt JH. Plasma fatty acid composition and incidence of coronary heart disease in middle aged adults: the Atherosclerosis Risk in Communities (ARIC) study. Nut Metab Cardiovasc Dis. 2003;13:256–266.
    1. Warensjo E, Sundstrom J, Vessby B, Cederholm T, Riserus U. Markers of dietary fat quality and fatty acid desaturation as predictors of total and cardiovascular mortality: a population-based prospective study. Am J Clin Nutr. 2008;88:203–209.
    1. Warensjo E, Jansson JH, Cederholm T, Boman K, Eliasson M, et al. Biomarkers of milk fat and the risk of myocardial infarction in men and women: a prospective, matched case-control study. Am J Clin Nutr. 2010;92:194–202.
    1. Day N, Oakes S, Luben R, Khaw KT, Bingham S, et al. EPIC-Norfolk: study design and characteristics of the cohort. European Prospective Investigation of Cancer. Br J Cancer. 1999;80:95–103.
    1. Khaw KT, Jakes R, Bingham S, Welch A, Luben R, et al. Work and leisure time physical activity assessed using a simple, pragmatic, validated questionnaire and incident cardiovascular disease and all-cause mortality in men and women: The European Prospective Investigation into Cancer in Norfolk prospective population study. Int J Epidemiol. 2006;35:1034–1043.
    1. Khaw KT, Bingham S, Welch A, Luben R, Wareham N, et al. Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European Prospective Investigation into Cancer and Nutrition. Lancet. 2001;357:657–663.
    1. Saadatian-Elahi M, Norat T, Bueno-de-Mesquita HB, Clavel F, Gonzalez CA, et al. Plasma concentrations of fatty acids in nine European countries: cross-sectional study within the European Prospective Investigation into Cancer and Nutrition (EPIC). IARC Sci Publ. 2002;156:215–218.
    1. Boekholdt SM, Kuivenhoven JA, Wareham NJ, Peters RJ, Jukema JW, et al. Plasma levels of cholesteryl ester transfer protein and the risk of future coronary artery disease in apparently healthy men and women: the prospective EPIC (European Prospective Investigation into Cancer and nutrition)-Norfolk population study. Circulation. 2004;110:1418–1423.
    1. Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, et al. The diet and 15-year death rate in the seven countries study. Am J Epidemiol. 1986;124:903–915.
    1. Siscovick DS, Lemaitre RN, Mozaffarian D. The fish story: a diet-heart hypothesis with clinical implications: n-3 polyunsaturated fatty acids, myocardial vulnerability, and sudden death. Circulation. 2003;107:2632–2634.
    1. Harris WS, Mozaffarian D, Rimm E, Kris-Etherton P, Rudel LL, et al. Omega-6 fatty acids and risk for cardiovascular disease: a science advisory from the American Heart Association Nutrition Subcommittee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention. Circulation. 2009;119:902–907.
    1. German JB, Gibson RA, Krauss RM, Nestel P, Lamarche B, et al. A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk. Eur J Nutr. 2009;48:191–203.
    1. Pereira MA, Jacobs DR, Jr, Van Horn L, Slattery ML, Kartashov AI, et al. Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. JAMA. 2002;287:2081–2089.
    1. Elwood PC, Pickering JE, Hughes J, Fehily AM, Ness AR. Milk drinking, ischaemic heart disease and ischaemic stroke II. Evidence from cohort studies. Eur J Clin Nutr. 2004;58:718–724.
    1. Wang L, Manson JE, Buring JE, Lee IM, Sesso HD. Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension. 2008;51:1073–1079.
    1. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336:1117–1124.
    1. Lemaitre RN, King IB, Mozaffarian D, Sotoodehnia N, Rea TD, et al. Plasma phospholipid trans fatty acids, fatal ischemic heart disease, and sudden cardiac death in older adults: the cardiovascular health study. Circulation. 2006;114:209–215.
    1. Mozaffarian D, Ludwig DS. Dietary guidelines in the 21st century–a time for food. JAMA. 2010;304:681–682.
    1. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr. 2010;91:502–509.
    1. Skeaff CM. Feasibility of recommending certain replacement or alternative fats. Eur J Clin Nutr. 2009;63:S34–S49.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit