title: Polyunsaturated Fat Intake Estimated by Circulating Biomarkers and Risk of Cardiovascular Disease and All-Cause Mortality in a Population-Based Cohort of 60-Year-Old Men and Women.
abstract: BACKGROUND
  High intake of polyunsaturated fatty acids (PUFAs) may reduce the risk of cardiovascular disease (CVD) and mortality. Large, prospective studies including both sexes and circulating PUFAs as dietary biomarkers are needed. We investigated sex-specific associations of the major dietary PUFAs, eicosapentaenoic acid, docohexaenoic acid, linoleic acid, and α-linolenic acid, with incident CVD and all-cause mortality in a population-based cohort.
  
  
  RESULTS
  PUFAs in serum cholesterol esters were measured at baseline in 60-year-old Swedish women (n=2193) and men (n=2039). With the use of national registers, 484 incident CVD events (294 men and 190 women) and 456 all-cause deaths (265 men and 191 women) were identified during follow-up (median, 14.5 years) in individuals without prior CVD at baseline. Associations of PUFAs with CVD and mortality were evaluated with Cox proportional hazard models. In multivariable-adjusted models, 1-SD increases in eicosapentaenoic acid and docohexaenoic acid were associated with lower risk of incident CVD among women (hazard ratio [HR], 0.79 [95% confidence interval (CI), 0.64-0.97] and 0.74 [95% CI, 0.61-0.89], respectively). α-Linolenic acid was associated with moderately increased CVD risk in women (HR, 1.16; 95% CI, 1.02-1.32). Inverse associations with all-cause mortality were observed for eicosapentaenoic acid and docohexaenoic acid among all participants (HR, 0.81 [95% CI, 0.72-0.91] and 0.80 [95% CI, 0.72-0.89], respectively) and for linoleic acid in men (HR, 0.73; 95% CI, 0.64-0.83).
  
  
  CONCLUSIONS
  Serum linoleic acid and very-long-chain n-3 PUFAs, partly reflecting vegetable oil and fish intake, respectively, were inversely associated with all-cause mortality. Inverse associations of eicosapentaenoic acid and docohexaenoic acid with incident CVD were observed only in women.
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.).
authors.forename: Matti
authors.initials: M
authors.lastname: Marklund
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.).
authors.forename: Karin
authors.initials: K
authors.lastname: Leander
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.).
authors.forename: Max
authors.initials: M
authors.lastname: Vikström
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.).
authors.forename: Federica
authors.initials: F
authors.lastname: Laguzzi
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.).
authors.forename: Bruna
authors.initials: B
authors.lastname: Gigante
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.).
authors.forename: Per
authors.initials: P
authors.lastname: Sjögren
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.).
authors.forename: Tommy
authors.initials: T
authors.lastname: Cederholm
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.).
authors.forename: Ulf
authors.initials: U
authors.lastname: de Faire
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.).
authors.forename: Mai-Lis
authors.initials: ML
authors.lastname: Hellénius
authors.affiliation: From Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden (M.M., P.S., T.C., U.R.); Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (K.L., M.V., F.L., B.G., U.d.F.) and Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital (B.G.), Karolinska Institutet, Stockholm, Sweden; and Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.-L.H.). ulf.riserus@pubcare.uu.se.
authors.forename: Ulf
authors.initials: U
authors.lastname: Risérus
mesh_terms: D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis; D002316:Cardiotonic Agents; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D002788:Cholesterol Esters / Q000097:blood* / Q000737:chemistry; D004041:Dietary Fats; D005231:Fatty Acids, Unsaturated / Q000097:blood; D005260:Female; D005395:Fish Oils; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010938:Plant Oils; D016016:Proportional Hazards Models; D064167:Recommended Dietary Allowances; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002316:Cardiotonic Agents; D002788:Cholesterol Esters; D004041:Dietary Fats; D005231:Fatty Acids, Unsaturated; D005395:Fish Oils; D008055:Lipids; D010938:Plant Oils
keywords: biological markers; cardiovascular diseases; cohort studies; epidemiology; fatty acids; mortality