title: High long-chain n-3 fatty acid intake attenuates the effect of high resting heart rate on cardiovascular mortality risk: a 24-year follow-up of Japanese general population.
abstract: BACKGROUND
  Increased resting heart rate (RHR) independently predicts cardiovascular mortality. Meanwhile, long-chain n-3 fatty acids (LCn3FAs) have a cardioprotective effect. Our aim was to evaluate whether higher LCn3FAs intake attenuates the elevated risk of cardiovascular mortality associated with increased RHR.
  
  
  METHODS
  We conducted a population-based 24-year prospective cohort study of Japanese, whose LCn3FAs intake is relatively high. Study participants included 8807 individuals aged 30-95 years from randomly selected areas across Japan without cardiovascular diseases and anti-hypertensive drugs at baseline. The primary endpoint was cardiovascular mortality, and the secondary endpoints were cardiac and stroke mortality during 24 years of follow-up. Individual dietary LCn3FAs intake was estimated from household-based 3-day weighed food records. RHR was obtained from 3 consecutive R-wave intervals on 12-lead electrocardiography. Cox models were used to estimate the multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) adjusting for possible confounders.
  
  
  RESULTS
  During the follow-up period, 617 cardiovascular deaths were observed. The median daily intake of LCn3FAs was 0.37% kcal (0.86g/day). The interaction between dietary LCn3FAs intake and RHR in the risk of cardiovascular mortality was statistically significant (p=0.033). The risk of cardiovascular mortality was significantly higher in the low-intake group (<0.37%kcal) with an RHR >85beats/min (bpm) [hazard ratio (HR), 1.67; 95% confidence interval (CI), 1.15-2.43], but not in the high-intake group (≥0.37%kcal) with an RHR >85bpm (HR, 0.92; 95% CI, 0.61-1.38), compared with those in the high-intake group with an RHR <70bpm. Similar results were observed with stroke mortality, but not with cardiac mortality.
  
  
  CONCLUSIONS
  The risk of cardiovascular mortality associated with increased RHR is elevated in participants with low dietary LCn3FAs intake, but not in participants with high dietary LCn3FAs intake in a representative Japanese general population. These results suggest that high dietary LCn3FAs intake may prevent cardiovascular mortality associated with increased RHR.
authors: Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Health Science, Shiga University of Medical Science, Otsu, Japan; Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan. Electronic address: hisataka@belle.shiga-med.ac.jp.
authors: Takashi
authors: T
authors: Hisamatsu
authors: Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
authors: Katsuyuki
authors: K
authors: Miura
authors: Department of Health Science, Shiga University of Medical Science, Otsu, Japan; Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
authors: Takayoshi
authors: T
authors: Ohkubo
authors: Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
authors: Takashi
authors: T
authors: Yamamoto
authors: Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
authors: Akira
authors: A
authors: Fujiyoshi
authors: Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
authors: Naoko
authors: N
authors: Miyagawa
authors: Department of School Nursing and Health Education, Osaka Kyoiku University, Osaka, Japan.
authors: Aya
authors: A
authors: Kadota
authors: Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
authors: Naoyuki
authors: N
authors: Takashima
authors: Section of Shokuiku, Department of Nutritional Education, National Institute of Health and Nutrition, Tokyo, Japan.
authors: Nagako
authors: N
authors: Okuda
authors: Department of Food Science and Nutrition, Osaka City University, Osaka, Japan.
authors: Katsushi
authors: K
authors: Yoshita
authors: Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
authors: Yoshikuni
authors: Y
authors: Kita
authors: Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Medical Statistics, Shiga University of Medical Science, Otsu, Japan.
authors: Yoshitaka
authors: Y
authors: Murakami
authors: Cardiovascular Epidemiology, Kyoto Women's University, Kyoto, Japan.
authors: Yasuyuki
authors: Y
authors: Nakamura
authors: Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.
authors: Tomonori
authors: T
authors: Okamura
authors: Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
authors: Minoru
authors: M
authors: Horie
authors: First Institute for Health Promotion and Health Care, Tokyo, Japan.
authors: Akira
authors: A
authors: Okayama
authors: Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
authors: Hirotsugu
authors: H
authors: Ueshima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000494:pharmacology*; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology / Q000517:prevention & control*; D015331:Cohort Studies; D004042:Dietary Fats, Unsaturated / Q000008:administration & dosage* / Q000494:pharmacology*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage* / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D013997:Time Factors
chemical_list: D002316:Cardiotonic Agents; D004042:Dietary Fats, Unsaturated; D015525:Fatty Acids, Omega-3
keywords: Cardiovascular disease; Electrocardiography; Fatty acids; Heart rate; Prevention