n-3 fatty acids and 5 year risk of death and cardiovascular disease events in patients with coronary artery disease.
n-3 fatty acids and 5 year risk of death and cardiovascular disease events in patients with coronary artery disease.
Year: 2003
Authors: A T Erkkila, S Lehto, K Pyorala, M I J Uusitupa.
Publication Name: Am. J. Clin. Nutr.
Publication Details: Volume 78; Page 65
Abstract:
The omega 3 (n3) fatty acid family including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from marine sources, and alpha-linolenic acid (ALA) from plant oils such as canola, have been reported to have protective roles in the development of coronary artery disease (CAD). High dietary intakes of the long chain n3 fatty acids EPA and DHA have been associated with reduced risk of CAD mortality in population studies, prospective cohort studies, and dietary intervention studies. Intervention studies have also found that high intakes of ALA are associated with a reduced risk of fatal and nonfatal CAD events in patients with acute myocardial infarction (AMI). Similarly, observational prospective studies have demonstrated ALA intake to be associated with a reduced risk of fatal ischemic events in women without prior CAD. However, a few studies have found that ALA content of serum or adipose tissue was not associated with reduced risk of CAD. Furthermore, in prospective cohort studies of patients with CAD, the relationship between dietary fat and serum lipid fatty acid profile and risk of death and recurrent CAD events, have been inconsistent. Thus, the aim of the present study was to evaluate the associations of diet and serum lipid fatty acid composition with mortality and cardiovascular events during a 5 year follow up of patients with clinically established CAD. Participants included 285 men and 130 women aged 33 – 74 who were diagnosed with existing CAD, and were patients in the EUROASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) study. All subjects participated in an interview and examination at = six months after hospitalization; at which time 4 day food records (3 weekdays and 1 weekend day) were completed. In addition, blood samples were collected following a 12h fast for subsequent analysis of serum total and lipoprotein concentrations. All participants were followed for a 5 year period. During the 5 year follow-up period, 36 patients died, 21 experienced myocardial infarctions, and 12 suffered a stroke. Serum total TG concentrations were significantly higher in patients who died than in the survivors. The patients who died also had higher intakes of fat and saturated fat, and lower fiber intakes than those who survived. The relative risks (RR’s) of death adjusted for cardiovascular disease risk factors for subjects in the highest tertile of cholesterol esters (CEs) FAs, compared with those in the lowest tertile, were 0.33 for ALA, 0.33 for EPA, and 0.31 for DHA. Higher proportions of ALA, EPA, and DHA in CEs were associated with a significantly lower risk of death (P values for trend = 0.063, 0.056, and 0.026, respectively). EPA and DHA levels in serum phospholipids tended to be associated with a lower risk of death; however, ALA in phospholipids did not show this relationship. The authors indicate that ALA, EPA, and DHA appear to be important dietary components that could potentially reduce the risk of death in patients with CAD. Furthermore, the benefits of these fatty acids can be obtained through the intake of foods without the use of supplements.
