title: Plasma phospholipid long-chain ω-3 fatty acids and total and cause-specific mortality in older adults: a cohort study.
abstract: BACKGROUND
  Long-chain ω-3 polyunsaturated fatty acids (ω3-PUFAs), including eicosapentaenoic acid (EPA) (20:5ω-3), docosapentaenoic acid (DPA) (22:5ω-3), and docosahexaenoic acid (DHA) (22:6ω-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 ω3-PUFAs or primary prevention.
  
  
  OBJECTIVE
  To investigate associations of plasma phospholipid EPA, DPA, DHA, and total ω3-PUFA levels with total and cause-specific mortality among healthy older adults not receiving supplements.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  4 U.S. communities.
  
  
  METHODS
  2692 U.S. adults aged 74 years (±5 years) without prevalent coronary heart disease (CHD), stroke, or heart failure at baseline.
  
  
  METHODS
  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 ω3-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 ω3-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 ω3-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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  Higher circulating individual and total ω3-PUFA levels are associated with lower total mortality, especially CHD death, in older adults.
  
  
  BACKGROUND
  National Institutes of Health.
authors.affiliation: Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. dmozaffa@hsph.harvard.edu
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
authors.forename: Rozenn N
authors.initials: RN
authors.lastname: Lemaitre
authors.forename: Irena B
authors.initials: IB
authors.lastname: King
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Song
authors.forename: Hongyan
authors.initials: H
authors.lastname: Huang
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sacks
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.forename: Molin
authors.initials: M
authors.lastname: Wang
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control; D015930:Diet Records; D004281:Docosahexaenoic Acids / Q000097:blood; D015118:Eicosapentaenoic Acid / Q000097:blood; D015525:Fatty Acids, Omega-3 / Q000097:blood*; D005231:Fatty Acids, Unsaturated / Q000097:blood; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000401:mortality / Q000517:prevention & control
chemical_list: D015415:Biomarkers; D015525:Fatty Acids, Omega-3; D005231:Fatty Acids, Unsaturated; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid; C026219:docosapentaenoic acid
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