title: Serum trans fatty acids, asymmetric dimethylarginine and risk of acute myocardial infarction and mortality in patients with suspected coronary heart disease: a prospective cohort study.
abstract: BACKGROUND
  Trans fatty acids (TFAs) have been found to impair flow mediated vasodilation and nitric oxide (NO) production. We sought to examine if serum TFA levels are associated with plasma levels of the NO inhibitor asymmetric dimethylarginine (ADMA) and if possible relationships between serum TFA and cardiovascular morbidity or mortality are mediated or modified by plasma ADMA levels.
  
  
  METHODS
  The cohort included patients who underwent coronary angiography for suspected coronary heart disease in 2000-2001. Serum trans 16:1n7 and trans 18:1 isomers were determined by gas liquid chromatography and the summation of these two TFAs is reported as TFA (percentage by weight (wt%) or concentration). Associations between TFAs and ADMA were estimated by calculating the Spearman's rank correlation coefficient (ρ), and risk associations with AMI, cardiovascular death and all-cause mortality across quartiles of TFAs (wt% or concentration) were explored by Cox modeling.
  
  
  RESULTS
  A total of 1364 patients (75 % men) with median (25(th),75(th) percentile) age 61 (54, 69) years, serum TFA 0.46 (0.36, 0.56) wt% and plasma ADMA 0.59 (0.50, 0.70) μmol/L were studied. Serum TFA levels (ρ = 0.21, p < 0.001), trans 16:1n7 (ρ = 0.22, p < 0.001) and trans 18:1 (ρ = 0.20, p < 0.001) levels were significantly correlated with plasma ADMA levels. During the median (25(th),75(th) percentile) follow-up time of 5.8 (4.5, 6.4) years, 129 (9.5 %) patients experienced an AMI, 124 (9.1 %) died, whereof 66 (53 %) due to cardiovascular causes. After multivariate adjustments no significant associations between serum TFA levels (wt% or concentration) and incident AMI, CV death and all-cause mortality were observed. Similar results were obtained when repeating the analyses with trans 16:1n7 and trans 18:1 individually. Plasma ADMA levels did not significantly modify the associations between TFA levels and outcomes.
  
  
  CONCLUSIONS
  Serum TFA levels were positively correlated with plasma ADMA levels. After multivariate adjustments, TFAs were not associated with incident AMI or mortality, and associations were not influenced by ADMA.
  
  
  BACKGROUND
  Clinicaltrials.gov Identifier: NCT00354081.
authors.affiliation: Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway. heibor@siv.no.
authors.forename: Heidi
authors.initials: H
authors.lastname: Borgeraas
authors.affiliation: Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Jens Kristoffer
authors.initials: JK
authors.lastname: Hertel
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Seifert
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.|Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Rolf K
authors.initials: RK
authors.lastname: Berge
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Pavol
authors.initials: P
authors.lastname: Bohov
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.|Labotatory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
authors.forename: Per Magne
authors.initials: PM
authors.lastname: Ueland
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.|Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.|KG Jebsen Center for Diabetes Research, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ottar
authors.initials: O
authors.lastname: Nygård
authors.affiliation: Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.|Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Jøran
authors.initials: J
authors.lastname: Hjelmesæth
mesh_terms: D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D011446:Prospective Studies; D044242:Trans Fatty Acids / Q000097:blood*
chemical_list: D044242:Trans Fatty Acids; C018524:N,N-dimethylarginine; D001120:Arginine