title: Trans-fatty acids and mortality in patients referred for coronary angiography: the Ludwigshafen Risk and Cardiovascular Health Study.
abstract: OBJECTIVE
  Trans-fatty acids (TFAs) are generated by the food industry and also occur naturally in trace amounts in dairy products. For the latter, beneficial health effects have been claimed, while there are numerous reports about TFA of industrial origin being hazardous to human health. Therefore, we aimed to investigate the association of TFA with mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study.
  
  
  RESULTS
  The fatty acid composition of erythrocyte membranes was analysed using the HS-Omega-3 Index(®) methodology in 3259 participants of the LURIC study at baseline. During a median of 10.0 years of follow-up, a total of 975 (29.9%) study participants died, 614 (18.8%) from cardiovascular causes including 254 (7.8%) sudden cardiac deaths (SCDs). Association of TFA with clinical outcome was investigated with Cox proportional hazards regression. Total TFAs were inversely associated with mortality due to cardiovascular causes or SCD. This was mainly driven by the naturally occurring TFA C16:1n-7t (trans-palmitoleic acid). The reduced risk of SCD associated with C16:1n-7t persisted after multivariate adjustment with a hazard ratio of 0.63 (0.46-0.86) for the third tertile compared with the first tertile. There was no association of any TFA subgroup with an increased risk of adverse outcomes.
  
  
  CONCLUSIONS
  In contrast to previous findings, the low concentrations of total TFAs found in LURIC were inversely associated with adverse cardiac outcomes. While the naturally occurring TFA C16:1n-7t was associated with reduced risk, no increased risk was found for industrially produced TFAs.
authors.affiliation: Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany Competence Cluster of Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany marcus.kleber@medma.uni-heidelberg.de.
authors.forename: Marcus E
authors.initials: ME
authors.lastname: Kleber
authors.affiliation: Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Graciela E
authors.initials: GE
authors.lastname: Delgado
authors.affiliation: Competence Cluster of Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lorkowski
authors.affiliation: Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria Synlab Academy, Synlab Services GmbH, Mannheim, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.affiliation: Omegametrix, Martinsried, Germany Department of Preventive Cardiology, Medizinische Klinik und Poliklinik I, Munich University, Munich, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: von Schacky
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000401:mortality*; D017023:Coronary Angiography / Q000401:mortality; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004910:Erythrocyte Membrane / Q000737:chemistry; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D044242:Trans Fatty Acids / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D044242:Trans Fatty Acids
keywords: Cardiovascular mortality; Mortality; Sudden cardiac death; Trans-fatty acids; Trans-palmitoleic acid