循环中的ω-6多不饱和脂肪酸与全因死亡率及特定病因死亡率：心血管健康研究
Circulating omega-6 polyunsaturated fatty acids and total and cause-specific mortality: the Cardiovascular Health Study.
作者信息
Wu Jason H Y, Lemaitre Rozenn N, King Irena B, Song Xiaoling, Psaty Bruce M, Siscovick David S, Mozaffarian Dariush
机构信息
From The George Institute for Global Health, Sydney Medical School, The University of Sydney, New South Wales, Australia (J.H.Y.W.); Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle (R.N.L., B.M.P.); the Department of Internal Medicine, University of New Mexico, Albuquerque (I.B.K.); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (X.S.); the Department of Epidemiology and Health Service, University of Washington, Seattle (B.M.P.); Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); New York Academy of Medicine, New York (D.S.S.); and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (D.M.).
出版信息
Circulation. 2014 Oct 7;130(15):1245-53. doi: 10.1161/CIRCULATIONAHA.114.011590. Epub 2014 Aug 14.
BACKGROUND
Although omega-6 polyunsaturated fatty acids (n-6 PUFA) have been recommended to reduce coronary heart disease (CHD), controversy remains about benefits versus harms, including concerns over theorized proinflammatory effects of n-6 PUFA. We investigated associations of circulating n-6 PUFA including linoleic acid (the major dietary PUFA), γ-linolenic acid, dihomo-γ-linolenic acid, and arachidonic acid, with total and cause-specific mortality in the Cardiovascular Health Study, a community-based U.S. cohort.
METHODS AND RESULTS
Among 2792 participants(aged ≥65 years) free of cardiovascular disease at baseline, plasma phospholipid n-6 PUFA were measured at baseline using standardized methods. All-cause and cause-specific mortality, and total incident CHD and stroke, were assessed and adjudicated centrally. Associations of PUFA with risk were assessed by Cox regression. During 34 291 person-years of follow-up (1992-2010), 1994 deaths occurred (678 cardiovascular deaths), with 427 fatal and 418 nonfatal CHD, and 154 fatal and 399 nonfatal strokes. In multivariable models, higher linoleic acid was associated with lower total mortality, with extreme-quintile hazard ratio =0.87 (P trend=0.005). Lower death was largely attributable to cardiovascular disease causes, especially nonarrhythmic CHD mortality (hazard ratio, 0.51; 95% confidence interval, 0.32-0.82; P trend=0.001). Circulating γ-linolenic acid, dihomo-γ-linolenic acid, and arachidonic acid were not significantly associated with total or cause-specific mortality (eg, for arachidonic acid and CHD death, the extreme-quintile hazard ratio was 0.97; 95% confidence interval, 0.70-1.34; P trend=0.87). Evaluated semiparametrically, linoleic acid showed graded inverse associations with total mortality (P=0.005). There was little evidence that associations of n-6 PUFA with total mortality varied by age, sex, race, or plasma n-3 PUFA. Evaluating both n-6 and n-3 PUFA, lowest risk was evident with highest levels of both.
CONCLUSIONS
High circulating linoleic acid, but not other n-6 PUFA, was inversely associated with total and CHD mortality in older adults.
背景
尽管已推荐ω-6多不饱和脂肪酸（n-6 PUFA）用于降低冠心病（CHD）风险，但关于其利弊仍存在争议，包括对n-6 PUFA理论上促炎作用的担忧。我们在美国一项基于社区的队列研究——心血管健康研究中，调查了循环中的n-6 PUFA（包括亚油酸（主要膳食PUFA）、γ-亚麻酸、二高-γ-亚麻酸和花生四烯酸）与全因死亡率和特定病因死亡率之间的关联。
方法与结果
在2792名基线时无心血管疾病的参与者（年龄≥65岁）中，使用标准化方法在基线时测量血浆磷脂n-6 PUFA。对全因和特定病因死亡率以及CHD和中风的总发病情况进行集中评估和判定。通过Cox回归评估PUFA与风险的关联。在34291人年的随访期间（1992 - 2010年），发生了1994例死亡（678例心血管疾病死亡），427例致命性和418例非致命性CHD，以及154例致命性和399例非致命性中风。在多变量模型中，较高的亚油酸与较低的全因死亡率相关，极端五分位数风险比 = 0.87（P趋势 = 0.005）。较低的死亡率主要归因于心血管疾病病因，尤其是非心律失常性CHD死亡率（风险比，0.51；95%置信区间，0.32 - 0.82；P趋势 = 0.001）。循环中的γ-亚麻酸、二高-γ-亚麻酸和花生四烯酸与全因或特定病因死亡率无显著关联（例如，对于花生四烯酸和CHD死亡，极端五分位数风险比为0.97；95%置信区间，0.70 - 1.34；P趋势 = 0.87）。经半参数评估，亚油酸与全因死亡率呈分级负相关（P = 0.005）。几乎没有证据表明n-6 PUFA与全因死亡率的关联因年龄、性别、种族或血浆n-3 PUFA而异。同时评估n-6和n-3 PUFA时，两者水平都最高时风险最低。
结论
循环中高水平的亚油酸而非其他n-6 PUFA与老年人的全因死亡率和CHD死亡率呈负相关。
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