title: Prediction of cardiovascular mortality in middle-aged men by dietary and serum linoleic and polyunsaturated fatty acids.
abstract: BACKGROUND
  Substitution of dietary polyunsaturated for saturated fat has long been recommended for the primary prevention of cardiovascular disease (CVD), but only a few prospective cohort studies have provided support for this advice.
  
  
  METHODS
  We assessed the association of dietary linoleic and total polyunsaturated fatty acid (PUFA) intake with cardiovascular and overall mortality in a population-based cohort of 1551 middle-aged men. Dietary fat composition was estimated with a 4-day food record and serum fatty acid composition.
  
  
  RESULTS
  During the 15-year follow-up, 78 men died of CVD and 225 of any cause. Total fat intake was not related to CVD or overall mortality. Men with an energy-adjusted dietary intake of linoleic acid (relative risk [RR] 0.39; 95% confidence interval [CI], 0.21-0.71) and PUFA (RR, 0.38; 95% CI, 0.20-0.70) in the upper third were less likely to die of CVD than men with intake in the lower third after adjustment for age. Multivariate adjustment weakened the association somewhat. Mortality from CVD was also lower for men with proportions of serum esterified linoleic acid (RR, 0.42; 95% CI, 0.21-0.80) and PUFA (RR, 0.25; 95% CI, 0.12-0.50) in the upper vs lower third, with some attenuation in multivariate analyses. Serum and to a lesser extent dietary linoleic acid and PUFA were also inversely associated with overall mortality.
  
  
  CONCLUSIONS
  Dietary polyunsaturated and more specifically linoleic fatty acid intake may have a substantial cardioprotective benefit that is also reflected in overall mortality. Dietary fat quality seems more important than fat quantity in the reduction of cardiovascular mortality in men.
authors.affiliation: Department of Physiology, University of Kuopio, Kuopio, Finland.
authors.forename: David E
authors.initials: DE
authors.lastname: Laaksonen
authors.forename: Kristiina
authors.initials: K
authors.lastname: Nyyssönen
authors.forename: Leo
authors.initials: L
authors.lastname: Niskanen
authors.forename: Tiina H
authors.initials: TH
authors.lastname: Rissanen
authors.forename: Jukka T
authors.initials: JT
authors.lastname: Salonen
mesh_terms: D000328:Adult; D017677:Age Distribution; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000401:mortality* / Q000517:prevention & control*; D002423:Cause of Death; D015331:Cohort Studies; D019587:Dietary Supplements; D005231:Fatty Acids, Unsaturated / Q000097:blood*; D005387:Finland / Q000453:epidemiology; D006801:Humans; D019787:Linoleic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D005231:Fatty Acids, Unsaturated; D019787:Linoleic Acid