03575nas a2200517 4500008004100000022001400041245012200055210006900177260001300246300001400259490000700273520210400280653001002384653000902394653002202403653001502425653001902440653002802459653002502487653001902512653002502531653001102556653002202567653001102589653001402600653003402614653002602648653002802674653000902702653001602711653002402727653002202751653001702773653001102790653001802801100002102819700002802840700001602868700002002884700002402904700002102928700002402949700002302973700002502996856003603021 2017 eng d a1524-462800aOmega-3 Fatty Acids and Incident Ischemic Stroke and Its Atherothrombotic and Cardioembolic Subtypes in 3 US Cohorts.0 aOmega3 Fatty Acids and Incident Ischemic Stroke and Its Atheroth c2017 Oct a2678-26850 v483 a
BACKGROUND AND PURPOSE: The associations of individual long-chain n-3 polyunsaturated fatty acids with incident ischemic stroke and its main subtypes are not well established. We aimed to investigate prospectively the relationship of circulating eicosapentaenoic acid, docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with risk of total ischemic, atherothrombotic, and cardioembolic stroke.
METHODS: We measured circulating phospholipid fatty acids at baseline in 3 separate US cohorts: CHS (Cardiovascular Health Study), NHS (Nurses' Health Study), and HPFS (Health Professionals Follow-Up Study). Ischemic strokes were prospectively adjudicated and classified into atherothrombotic (large- and small-vessel infarctions) or cardioembolic by imaging studies and medical records. Risk according to fatty acid levels was assessed using Cox proportional hazards (CHS) or conditional logistic regression (NHS, HPFS) according to study design. Cohort findings were pooled using fixed-effects meta-analysis.
RESULTS: A total of 953 incident ischemic strokes were identified (408 atherothrombotic, 256 cardioembolic, and 289 undetermined subtypes) during median follow-up of 11.2 years (CHS) and 8.3 years (pooled, NHS and HPFS). After multivariable adjustment, lower risk of total ischemic stroke was seen with higher DPA (highest versus lowest quartiles; pooled hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.58-0.92) and DHA (HR, 0.80; 95% CI, 0.64-1.00) but not eicosapentaenoic acid (HR, 0.94; 95% CI, 0.77-1.19). DHA was associated with lower risk of atherothrombotic stroke (HR, 0.53; 95% CI, 0.34-0.83) and DPA with lower risk of cardioembolic stroke (HR, 0.58; 95% CI, 0.37-0.92). Findings in each individual cohort were consistent with pooled results.
CONCLUSIONS: In 3 large US cohorts, higher circulating levels of DHA were inversely associated with incident atherothrombotic stroke and DPA with cardioembolic stroke. These novel findings suggest differential pathways of benefit for DHA, DPA, and eicosapentaenoic acid.
10aAdult10aAged10aAged, 80 and over10aBiomarkers10aBrain Ischemia10aCardiovascular Diseases10aCase-Control Studies10aCohort Studies10aFatty Acids, Omega-310aFemale10aFollow-Up Studies10aHumans10aIncidence10aIntracranial Arteriosclerosis10aIntracranial Embolism10aIntracranial Thrombosis10aMale10aMiddle Aged10aProspective Studies10aRandom Allocation10aRisk Factors10aStroke10aUnited States1 aSaber, Hamidreza1 aYakoob, Mohammad, Yawar1 aShi, Peilin1 aLongstreth, W T1 aLemaitre, Rozenn, N1 aSiscovick, David1 aRexrode, Kathryn, M1 aWillett, Walter, C1 aMozaffarian, Dariush uhttps://chs-nhlbi.org/node/7490