Published online before print January 3, 2005, doi: 10.1161/01.CIR.0000152099.87287.83
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(Circulation. 2005;111:157-164.)
© 2005 American Heart Association, Inc.
Coronary Heart Disease |
Interplay Between Different Polyunsaturated Fatty Acids and Risk of Coronary Heart Disease in Men
From the Channing Laboratory (D.M., A.A., F.B.H., M.J.S., W.C.W., E.B.R.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, and the Departments of Nutrition and Epidemiology (D.M., A.A., F.B.H., M.J.S., W.C.W., E.B.R.), Harvard School of Public Health, Boston, Mass, and the Cardiovascular Health Research Unit (D.S.S.), Departments of Medicine and Epidemiology, University of Washington, Seattle, Wash.
Correspondence to Dr D. Mozaffarian, 665 Huntington Ave, Bldg 2, Room 315, Boston, MA 02115. E-mail dmozaffa{at}hsph.harvard.edu
Received July 17, 2004; revision received October 7, 2004; accepted October 19, 2004.
Background— Consumption of polyunsaturated fatty acids (PUFAs) may reduce coronary heart disease (CHD) risk, but n-6 PUFAs may compete with n-3 PUFA metabolism and attenuate benefits. Additionally, seafood-based, long-chain n-3 PUFAs may modify the effects of plant-based, intermediate-chain n-3 PUFAs. However, the interactions of these PUFAs in relation to CHD risk are not well established.
Methods and Results— Among 45 722 men free of known cardiovascular disease in 1986, usual dietary intake was assessed at baseline and every 4 years by using validated food-frequency questionnaires. CHD incidence was prospectively ascertained. Over 14 years of follow-up, participants experienced 218 sudden deaths, 1521 nonfatal myocardial infarctions (MIs), and 2306 total CHD events (combined sudden death, other CHD deaths, and nonfatal MI). In multivariate-adjusted analyses, both long-chain and intermediate-chain n-3 PUFA intakes were associated with lower CHD risk, without modification by n-6 PUFA intake. For example, men with 
median long-chain n-3 PUFA intake (250 mg/d) had a reduced risk of sudden death whether n-6 PUFA intake was below (<11.2 g/d; hazard ratio [HR]=0.52; 95% confidence interval [CI]=0.34 to 0.79) or above (11.2 g/d; HR=0.60; 95% CI=0.39 to 0.93) the median compared with men with a < median intake of both. In similar analyses, median intake of intermediate-chain n-3 PUFAs (1080 mg/d) was associated with a reduced total CHD risk whether n-6 PUFA intake was lower (HR=0.88; 95% CI=0.78 to 0.99) or higher (HR=0.89; 95% CI=0.79 to 0.99) compared with a < median intake of both. Intermediate-chain n-3 PUFAs were particularly associated with CHD risk when long-chain n-3 PUFA intake was very low (<100 mg/d); among these men, each 1 g/d of intermediate-chain n-3 PUFA intake was associated with an 
50% lower risk of nonfatal MI (HR=0.42; 95% CI=0.23 to 0.75) and total CHD (HR=0.53; 95% CI=0.34 to 0.83).
Conclusions— n-3 PUFAs from both seafood and plant sources may reduce CHD risk, with little apparent influence from background n-6 PUFA intake. Plant-based n-3 PUFAs may particularly reduce CHD risk when seafood-based n-3 PUFA intake is low, which has implications for populations with low consumption or availability of fatty fish.
Key Words: coronary disease • diet • fatty acids • nutrition
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