title: The association between dietary omega-3 fatty acids and cardiovascular death: the Singapore Chinese Health Study.
abstract: BACKGROUND
  Although studies suggest that omega-3 fatty acids intake may reduce cardiovascular disease (CVD) mortality risk, few studies have differentiated dietary eicosapentaenoic/docosahexaenoic acid (EPA/DHA) from alpha-linolenic acid (ALA), and epidemiological research in Asian populations is limited.
  
  
  METHODS
  The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998. Usual diet was measured at recruitment using a validated semiquantitative food-frequency questionnaire, and mortality information was identified via registry linkage up to 31 December 2011. Cox proportional hazard models were used to calculate hazard ratios (HRs) with adjustment for potential confounders.
  
  
  RESULTS
  We documented 4780 cardiovascular deaths (including 2697 coronary heart disease (CHD) deaths and 1298 stroke deaths) during 890,473 person-years of follow up. Omega-3 fatty acids intake was monotonically associated with reduced risk of cardiovascular mortality. Compared to the lowest quartile, the HR was 0.88 (95% confidence interval, CI, 0.81-0.96), 0.88 (95% CI 0.80-0.97), and 0.83 (95% CI 0.74-0.92) for the second, third, and highest quartile, respectively (p-trend = 0.003). Both EPA/DHA and ALA were independently associated with reduced risk of cardiovascular mortality: HR comparing extreme quartiles was 0.86 (95% CI 0.77-0.96, p-trend = 0.002) and 0.81 (95% CI 0.73-0.90, p-trend < 0.001), respectively. The associations were similar for deaths from CHD and stroke and persisted in participants who were free of CVD at baseline.
  
  
  CONCLUSIONS
  Higher intakes of marine (EPA/DHA) and plant (ALA) omega-3 fatty acids are both associated with reduced risk of cardiovascular mortality in a Chinese population.
authors.affiliation: National Heart Centre Singapore, Singapore.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Koh
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore ephanp@nus.edu.sg.
authors.forename: An
authors.initials: A
authors.lastname: Pan
authors.affiliation: Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA.
authors.forename: Renwei
authors.initials: R
authors.lastname: Wang
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Odegaard
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pereira
authors.affiliation: Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore Duke-NUS Graduate Medical School Singapore, Singapore.
authors.forename: Woon-Puay
authors.initials: WP
authors.lastname: Koh
mesh_terms: D000368:Aged; D044466:Asian People; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D002681:China / Q000208:ethnology; D004032:Diet / Q000208:ethnology; D004281:Docosahexaenoic Acids / Q000008:administration & dosage*; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage*; D005247:Feeding Behavior / Q000208:ethnology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D017962:alpha-Linolenic Acid / Q000008:administration & dosage*
chemical_list: D017962:alpha-Linolenic Acid; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid
keywords: Cardiovascular diseases; Chinese; epidemiology; fatty acids; mortality; nutrition