(29-04-13) Plasma Phospholipid Long-Chain ù-3 Fatty Acids and Total and Cause-Specific Mortality in Older Adults: A Cohort Study.

Mozaffarian D, Lemaitre RN, King IB, Song X, Huang H, Sacks FM, Rimm EB, Wang M, Siscovick DS.
Abstract
Chinese translation BACKGROUND: Long-chain ù-3 polyunsaturated fatty acids (ù3-PUFAs), including eicosapentaenoic acid (EPA) (20:5ù-3), docosapentaenoic acid (DPA) (22:5ù-3), and docosahexaenoic acid (DHA) (22:6ù-3), have been shown to reduce cardiovascular risk, but effects on cause-specific and total mortality and potential dose-responses remain controversial. Most observational studies have assessed self-reported dietary intake and most randomized trials have tested effects of adding supplements to dietary intake and evaluated secondary prevention, thus limiting inference for dietary ù3-PUFAs or primary prevention.
OBJECTIVE:
To investigate associations of plasma phospholipid EPA, DPA, DHA, and total ù3-PUFA levels with total and cause-specific mortality among healthy older adults not receiving supplements.
DESIGN:
Prospective cohort study.
SETTING:
4 U.S. communities.
PARTICIPANTS:
2692 U.S. adults aged 74 years (±5 years) without prevalent coronary heart disease (CHD), stroke, or heart failure at baseline.
MEASUREMENTS:
Phospholipid fatty acid levels and cardiovascular risk factors were measured in 1992. Relationships with total and cause-specific mortality and incident fatal or nonfatal CHD and stroke through 2008 were assessed.
RESULTS:
During 30 829 person-years, 1625 deaths (including 570 cardiovascular deaths), 359 fatal and 371 nonfatal CHD events, and 130 fatal and 276 nonfatal strokes occurred. After adjustment, higher plasma levels of ù3-PUFA biomarkers were associated with lower total mortality, with extreme-quintile hazard ratios of 0.83 for EPA (95% CI, 0.71 to 0.98; P for trend = 0.005), 0.77 for DPA (CI, 0.66 to 0.90; P for trend = 0.008), 0.80 for DHA (CI, 0.67 to 0.94; P for trend = 0.006), and 0.73 for total ù3-PUFAs (CI, 0.61 to 0.86; P for trend < 0.001). Lower risk was largely attributable to fewer cardiovascular than noncardiovascular deaths. Individuals in the highest quintile of phospholipid ù3-PUFA level lived an average of 2.22 more years (CI, 0.75 to 3.13 years) after age 65 years than did those in the lowest quintile.
LIMITATION:
Temporal changes in fatty acid levels and misclassification of causes of death may have resulted in underestimated associations, and unmeasured or imperfectly measured covariates may have caused residual confounding.
CONCLUSION:
Higher circulating individual and total ù3-PUFA levels are associated with lower total mortality, especially CHD death, in older adults.

Source: Ann Intern Med. 2013 Apr 2;158(7):515-25. doi: 10.7326/0003-4819-158-7-201304020-00003

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