TY - JOUR T1 - Biomarkers of Dietary Omega-6 Fatty Acids and Incident Cardiovascular Disease and Mortality. JF - Circulation Y1 - 2019 A1 - Marklund, Matti A1 - Wu, Jason H Y A1 - Imamura, Fumiaki A1 - Del Gobbo, Liana C A1 - Fretts, Amanda A1 - de Goede, Janette A1 - Shi, Peilin A1 - Tintle, Nathan A1 - Wennberg, Maria A1 - Aslibekyan, Stella A1 - Chen, Tzu-An A1 - de Oliveira Otto, Marcia C A1 - Hirakawa, Yoichiro A1 - Eriksen, Helle Højmark A1 - Kröger, Janine A1 - Laguzzi, Federica A1 - Lankinen, Maria A1 - Murphy, Rachel A A1 - Prem, Kiesha A1 - Samieri, Cecilia A1 - Virtanen, Jyrki A1 - Wood, Alexis C A1 - Wong, Kerry A1 - Yang, Wei-Sin A1 - Zhou, Xia A1 - Baylin, Ana A1 - Boer, Jolanda M A A1 - Brouwer, Ingeborg A A1 - Campos, Hannia A1 - Chaves, Paulo H M A1 - Chien, Kuo-Liong A1 - de Faire, Ulf A1 - Djoussé, Luc A1 - Eiriksdottir, Gudny A1 - El-Abbadi, Naglaa A1 - Forouhi, Nita G A1 - Michael Gaziano, J A1 - Geleijnse, Johanna M A1 - Gigante, Bruna A1 - Giles, Graham A1 - Guallar, Eliseo A1 - Gudnason, Vilmundur A1 - Harris, Tamara A1 - Harris, William S A1 - Helmer, Catherine A1 - Hellenius, Mai-Lis A1 - Hodge, Allison A1 - Hu, Frank B A1 - Jacques, Paul F A1 - Jansson, Jan-Håkan A1 - Kalsbeek, Anya A1 - Khaw, Kay-Tee A1 - Koh, Woon-Puay A1 - Laakso, Markku A1 - Leander, Karin A1 - Lin, Hung-Ju A1 - Lind, Lars A1 - Luben, Robert A1 - Luo, Juhua A1 - McKnight, Barbara A1 - Mursu, Jaakko A1 - Ninomiya, Toshiharu A1 - Overvad, Kim A1 - Psaty, Bruce M A1 - Rimm, Eric A1 - Schulze, Matthias B A1 - Siscovick, David A1 - Skjelbo Nielsen, Michael A1 - Smith, Albert V A1 - Steffen, Brian T A1 - Steffen, Lyn A1 - Sun, Qi A1 - Sundström, Johan A1 - Tsai, Michael Y A1 - Tunstall-Pedoe, Hugh A1 - Uusitupa, Matti I J A1 - van Dam, Rob M A1 - Veenstra, Jenna A1 - Monique Verschuren, W M A1 - Wareham, Nick A1 - Willett, Walter A1 - Woodward, Mark A1 - Yuan, Jian-Min A1 - Micha, Renata A1 - Lemaitre, Rozenn N A1 - Mozaffarian, Dariush A1 - Riserus, Ulf AB -

BACKGROUND: Global dietary recommendations for and cardiovascular effects of linoleic acid, the major dietary omega-6 fatty acid, and its major metabolite, arachidonic acid, remain controversial. To address this uncertainty and inform international recommendations, we evaluated how in vivo circulating and tissue levels of linoleic acid (LA) and arachidonic acid (AA) relate to incident cardiovascular disease (CVD) across multiple international studies.

METHODS: We performed harmonized, de novo, individual-level analyses in a global consortium of 30 prospective observational studies from 13 countries. Multivariable-adjusted associations of circulating and adipose tissue LA and AA biomarkers with incident total CVD and subtypes (coronary heart disease, ischemic stroke, cardiovascular mortality) were investigated according to a prespecified analytic plan. Levels of LA and AA, measured as the percentage of total fatty acids, were evaluated linearly according to their interquintile range (ie, the range between the midpoint of the first and fifth quintiles), and categorically by quintiles. Study-specific results were pooled using inverse-variance-weighted meta-analysis. Heterogeneity was explored by age, sex, race, diabetes mellitus, statin use, aspirin use, omega-3 levels, and fatty acid desaturase 1 genotype (when available).

RESULTS: In 30 prospective studies with medians of follow-up ranging 2.5 to 31.9 years, 15 198 incident cardiovascular events occurred among 68 659 participants. Higher levels of LA were significantly associated with lower risks of total CVD, cardiovascular mortality, and ischemic stroke, with hazard ratios per interquintile range of 0.93 (95% CI, 0.88-0.99), 0.78 (0.70-0.85), and 0.88 (0.79-0.98), respectively, and nonsignificantly with lower coronary heart disease risk (0.94; 0.88-1.00). Relationships were similar for LA evaluated across quintiles. AA levels were not associated with higher risk of cardiovascular outcomes; in a comparison of extreme quintiles, higher levels were associated with lower risk of total CVD (0.92; 0.86-0.99). No consistent heterogeneity by population subgroups was identified in the observed relationships.

CONCLUSIONS: In pooled global analyses, higher in vivo circulating and tissue levels of LA and possibly AA were associated with lower risk of major cardiovascular events. These results support a favorable role for LA in CVD prevention.

VL - 139 IS - 21 ER -