Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Atherosclerosis. 2013 Sep;230(1):140-7. doi: 10.1016/j.atherosclerosis.2013.06.015. Epub 2013 Jul 12.
The issue of whether saturated fats and trans fats are superior predictors of all-cause death and cardiovascular disease than n-3 polyunsaturated fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), remains a matter of contention. Furthermore, few studies have examined the relationship between fatty acids and the outcomes of cardiovascular disease (CVD) in Asian populations. The aim of this study was to compare the effectiveness of various plasma fatty acids as predictors for all-cause death and CVD events in an ethnic Chinese population.
This study assembled a community-based prospective cohort, comprising 1833 participants (60.6 ± 10.5 yrs, 44.5% women) who underwent a comprehensive evaluation of fatty acids in blood using gas chromatography. None of the subjects had a history of CVD at the time of recruitment.
A total of 568 individuals died and 275 individuals developed CVD during the follow-up period (median of 9.6 years; interquartile range of 8.9-10.5 years). Following adjustment for established cardiovascular risk factors, the relative risk of all-cause death in the highest quartile, compared with the lowest quartile, was 1.33 for saturated fats (95% confidence interval [CI], 1.01-1.75, test for trend, P = 0.015), 1.71 for trans fats (95% CI, 1.27-2.31, test for trend, P = 0.0003), 0.77 for EPA (95% CI, 0.59-1.00, test for trend, P = 0.048), and 0.89 for DHA (95% CI, 0.68-1.18, test for trend, P = 0.354). Similar patterns were observed for CVD events. Trans fats presented the largest area under the receiver operator characteristic curve (0.740, 95% CI, 0.716-0.766) for the prediction of all-cause death. A mutually adjusted two-marker model indicated that saturated fats and trans fats were significant predictors of all-cause death and CVD; however, the other fatty acids were not. In addition, trans fats presented the greatest improvement in net reclassification for all-cause death (7.7%, P = 0.003), followed by EPA (3.8%, P = 0.033). Saturated fats presented the greatest improvement in net reclassification for CVD events (5.6%, P = 0.039).
Our data provides strong evidence to support that plasma saturated fats and trans fats can predict all-cause death and CVD more effectively than other fatty acid markers.
关于饱和脂肪和反式脂肪是否比 n-3 多不饱和脂肪酸（如二十碳五烯酸（EPA）和二十二碳六烯酸（DHA））更能预测全因死亡和心血管疾病，仍存在争议。此外，很少有研究探讨脂肪酸与亚洲人群心血管疾病（CVD）结局之间的关系。本研究旨在比较不同血浆脂肪酸作为汉族人群全因死亡和 CVD 事件预测因子的有效性。
本研究组建了一个基于社区的前瞻性队列，共纳入 1833 名参与者（60.6±10.5 岁，44.5%为女性），采用气相色谱法对血液中的脂肪酸进行全面评估。在招募时，所有受试者均无 CVD 病史。
在随访期间，共有 568 人死亡，275 人发生 CVD（中位数为 9.6 年；四分位间距为 8.9-10.5 年）。在校正了已确立的心血管危险因素后，与最低四分位相比，饱和脂肪最高四分位的全因死亡相对风险为 1.33（95%置信区间[CI]为 1.01-1.75，趋势检验，P=0.015），反式脂肪为 1.71（95%CI 为 1.27-2.31，趋势检验，P=0.0003），EPA 为 0.77（95%CI 为 0.59-1.00，趋势检验，P=0.048），DHA 为 0.89（95%CI 为 0.68-1.18，趋势检验，P=0.354）。CVD 事件也观察到类似的模式。反式脂肪对全因死亡的预测具有最大的受试者工作特征曲线下面积（0.740，95%CI 为 0.716-0.766）。相互调整的两标志物模型表明，饱和脂肪和反式脂肪是全因死亡和 CVD 的重要预测因子；然而，其他脂肪酸则不是。此外，反式脂肪对全因死亡的净重新分类有最大的改善（7.7%，P=0.003），其次是 EPA（3.8%，P=0.033）。饱和脂肪对 CVD 事件的净重新分类有最大的改善（5.6%，P=0.039）。
我们的数据提供了强有力的证据，支持血浆饱和脂肪和反式脂肪比其他脂肪酸标志物更能有效地预测全因死亡和 CVD。
