title: N-6 and N-3 fatty acid cholesteryl esters in relation to fatal CHD in a Dutch adult population: a nested case-control study and meta-analysis.
abstract: BACKGROUND
  Dietary polyunsaturated fatty acids (PUFA) are inversely related to coronary heart disease (CHD) in epidemiological studies. We examined the associations of plasma n-6 and n-3 PUFA in cholesteryl esters with fatal CHD in a nested case-control study. Additionally, we performed a dose-response meta-analysis of similar prospective studies on cholesteryl ester PUFA.
  
  
  METHODS
  We used data from two population-based cohort studies in Dutch adults aged 20-65 y. Blood and data collection took place from 1987-1997 and subjects were followed for 8-19 y. We identified 279 incident cases of fatal CHD and randomly selected 279 controls, matched on age, gender, and enrollment date. Odds ratios (OR) were calculated per standard deviation (SD) increase of cholesteryl ester PUFA.
  
  
  RESULTS
  After adjustment for confounders, the OR (95%CI) for fatal CHD per SD increase in plasma linoleic acid was 0.89 (0.74-1.06). Additional adjustment for plasma total cholesterol and systolic blood pressure attenuated this association (OR:0.95; 95%CI: 0.78-1.15). Arachidonic acid was not associated with fatal CHD (OR per SD:1.11; 95%CI: 0.92-1.35). The ORs (95%CI) for fatal CHD for an SD increase in n-3 PUFA were 0.92 (0.74-1.15) for alpha-linolenic acid and 1.06 (0.88-1.27) for EPA-DHA. In the meta-analysis, a 5% higher linoleic acid level was associated with a 9% lower risk (relative risk: 0.91; 95% CI: 0.84-0.98) of CHD. The other fatty acids were not associated with CHD.
  
  
  CONCLUSIONS
  In this Dutch population, n-6 and n-3 PUFA in cholesteryl esters were not significantly related to fatal CHD. Our data, together with findings from previous prospective studies, support that linoleic acid in plasma cholesteryl is inversely associated with CHD.
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands. Janette.deGoede@wur.nl
authors.forename: Janette
authors.initials: J
authors.lastname: de Goede
authors.forename: W M Monique
authors.initials: WM
authors.lastname: Verschuren
authors.forename: Jolanda M A
authors.initials: JM
authors.lastname: Boer
authors.forename: Lisa D M
authors.initials: LD
authors.lastname: Verberne
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Geleijnse
mesh_terms: D000328:Adult; D000368:Aged; D016718:Arachidonic Acid / Q000008:administration & dosage / Q000097:blood*; D016022:Case-Control Studies; D002788:Cholesterol Esters / Q000097:blood*; D003327:Coronary Disease / Q000097:blood / Q000401:mortality*; D004032:Diet; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000097:blood*; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage / Q000097:blood*; D005260:Female; D006801:Humans; D019787:Linoleic Acid / Q000008:administration & dosage / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D012307:Risk Factors
chemical_list: D002788:Cholesterol Esters; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D016718:Arachidonic Acid; D019787:Linoleic Acid