title: Plasma phospholipid trans-fatty acids levels, cardiovascular diseases, and total mortality: the cardiovascular health study.
abstract: BACKGROUND
  While self-reported trans-fatty acid (TFA) consumption is linked to coronary heart disease (CHD), relationships between objective biomarkers of TFA subtypes (t-16:1n9, total t-18:1, and cis/trans-(c/t-), t/c- and t/t-18:2) and cardiovascular disease (CVD) or total mortality are not well established.
  
  
  RESULTS
  We evaluated 2742 adults in the Cardiovascular Health Study, aged 74±5 years and free of prevalent CVD, with plasma phospholipid TFA measures in 1992. Incident fatal and nonfatal CHD events, CVD and non-CVD mortality, and total mortality were centrally adjudicated through 2010. Risks were assessed using Cox proportional hazards. During 31 494 person-years, 1735 total deaths and 639 total CHD events occurred. In the multivariate model including mutual adjustment for the 5 TFA subtypes, circulating t/t-18:2 was associated with higher total mortality (extreme quintile hazard ratio (HR)=1.23, 95% CI=1.04 to 1.44, P-trend=0.01), CVD mortality (HR=1.40, 95% CI=1.05 to 1.86, P-trend=0.02), and total CHD (HR=1.39, 95% CI=1.06 to 1.83, P-trend=0.01). t/c-18:2 was positively related to total mortality (HR=1.19, P-trend=0.05), total CHD (HR=1.67, P-trend=0.002), and nonfatal CHD (HR=2.06, P-trend=0.002) after mutual adjustment; these associations were insignificant without mutual adjustment. Neither t-16:1n9 nor t-18:1 was significantly associated with total mortality or CVD, nor was c/t-18:2 if we excluded early cases.
  
  
  CONCLUSIONS
  Among circulating TFAs, t/t-18:2 was most adversely associated with total mortality, mainly due to the increased risk of CVD. t/c-18:2 was also positively associated with total mortality and CHD, but only after adjustment for other TFAs. These results highlight the need for further investigation of dietary sources, nondietary determinants, and health effects of specific TFA subtypes, especially t-18:2 isomers.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (Q.W., E.B.R., M.W., D.M.).
authors.forename: Qianyi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK (F.I.).
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Imamura
authors.affiliation: Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (R.N.L., D.S.).
authors.forename: Rozenn N
authors.initials: RN
authors.lastname: Lemaitre
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (Q.W., E.B.R., M.W., D.M.) Department of Nutrition, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R., D.M.) Division of Cardiovascular Medicine, and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R., D.M.).
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (Q.W., E.B.R., M.W., D.M.) Department of Biostatistics, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.W.).
authors.forename: Molin
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, University of New Mexico, Albuquerque, NM (I.B.K.).
authors.forename: Irena B
authors.initials: IB
authors.lastname: King
authors.affiliation: Public Health Sciences Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA (X.S.).
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Song
authors.affiliation: Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (R.N.L., D.S.) Department of Epidemiology, University of Washington, New York Academy of Medicine, New York, NY (D.S.).
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (Q.W., E.B.R., M.W., D.M.) Department of Nutrition, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R., D.M.) Friedman School of Nutrition Science and Policy, Tufts University, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.M.) Division of Cardiovascular Medicine, and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R., D.M.).
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D004041:Dietary Fats; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality; D010743:Phospholipids / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D044242:Trans Fatty Acids / Q000097:blood*
chemical_list: D015415:Biomarkers; D004041:Dietary Fats; D010743:Phospholipids; D044242:Trans Fatty Acids
keywords: cardiovascular diseases; coronary disease; nutrition; total mortality; trans–fatty acids