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Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study
Open accessAbstract
Background: Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid ( ALA ), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PRE vención con DI eta MED iterránea ( PREDIMED ) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption ( r =0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA , supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Clinical Trial Registration: URL : http://www.Controlled-trials.com/ . Unique identifier: ISRCTN 35739639.
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2 retracted
RETRACTED: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1200303 · Cited by 4,257
Self-citationRetractedEstruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmc1806491 · Cited by 1,008
Self-citationRetractedOmega-3 Fatty Acids and Cardiovascular Disease
Mozaffarian, D., & Wu, J. H. Y. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.06.063 · Cited by 1,771
Schröder, H., Fitó, M., Estruch, R., Martínez-González, M. A., Corella, D., Salas-Salvadó, J., Lamuela-Raventós, R., Ros, E., Salaverría, I., Fiol, M., et al. (2011) · The Journal of Nutrition · doi:10.3945/jn.110.135566 · Cited by 1,624
Self-citationn–3 Fatty Acids and Cardiovascular Events after Myocardial Infarction
Kromhout, D., Giltay, E. J., & Geleijnse, J. M. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1003603 · Cited by 936
Fernández-Ballart, J. D., Piñol, J. L., Zazpe, I., Corella, D., Carrasco, P., Toledo, E., Perez-Bauer, M., Martínez-González, M. Á., Salas-Salvadó, J., & Martín-Moreno, J. M. (2010) · British Journal of Nutrition · doi:10.1017/s0007114509993837 · Cited by 898
Self-citationCohort Profile: Design and methods of the PREDIMED study
Martinez-Gonzalez, M. A., Corella, D., Salas-Salvado, J., Ros, E., Covas, M. I., Fiol, M., Warnberg, J., Aros, F., Ruiz-Gutierrez, V., Lamuela-Raventos, R. M., et al. (2012) · International Journal of Epidemiology · doi:10.1093/ije/dyq250 · Cited by 671
Self-citationComponents of a Cardioprotective Diet: New Insights
Mozaffarian, D., Appel, L. J., & Van Horn, L. (2011) · Circulation · doi:10.1161/circulationaha.110.968735 · Cited by 571
Validation of the Minnesota Leisure Time Physical Activity Questionnaire in Spanish Men
Elosua, R., Marrugat, J., Molina, L., Pons, S., & Pujol, E. (1994) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116966 · Cited by 499
Saadatian-Elahi, M., Slimani, N., Chajès, V., Jenab, M., Goudable, J., Biessy, C., Ferrari, P., Byrnes, G., Autier, P., Peeters, P. H., et al. (2009) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.2008.26834 · Cited by 213
Cited by
The review of alpha‐linolenic acid: Sources, metabolism, and pharmacology
Yuan, Q., Xie, F., Huang, W., Hu, M., Yan, Q., Chen, Z., Zheng, Y., & Liu, L. (2022) · Phytotherapy Research · doi:10.1002/ptr.7295 · Cited by 285
Metadata
- Authors
- Sala‐Vila, A., Guasch‐Ferré, M., Hu, F. B., Sánchez‐Tainta, A., Bulló, M., Serra‐Mir, M., López‐Sabater, C., Sorlí, J. V., Arós, F., Fiol, M., Muñoz, M. A., Serra‐Majem, L., Martínez, J. A., Corella, D., Fitó, M., Salas‐Salvadó, J., Martínez‐González, M. A., Estruch, R., Ros, E., the PREDIMED Investigators, Pérez‐Heras, A., Viñas, C., Casas, R., de Santamaría, L., Romero, S., Sacanella, E., Chiva, G., Valderas, P., Arranz, S., Baena, J. M., García, M., Oller, M., Amat, J., Duaso, I., García, Y., Iglesias, C., Simón, C., Quinzavos, L., Parra, L., Liroz, M., Benavent, J., Clos, J., Pla, I., Amorós, M., Bonet, M. T., Martin, M. T., Sánchez, M. S., Altirriba, J., Manzano, E., Altés, A., Cofán, M., Valls‐Pedret, C., Doménech, M., Gilabert, R., Bargalló, N., González, R., Molina, C., Márquez, F., Babio, N., Sorli, M., García Roselló, J., Diaz‐López A, A., Martin, F., Tort, R., Isach, A., Costa, B., Cabré, J. J., Fernández‐Ballart, J., Ibarrola‐Jurado, N., Alegret, C., Martínez, P., Millán, S., Piñol, J. L., Basora, T., Hernández, J. M., Toledo, E., Buil‐Cosiales, P., Ruiz‐Canela, M., Sanjulián, B., Díez‐Espino, J., Extremera‐Urabayen, V., García‐Arellano, A., Zazpe, I., Basterra‐Gortari, F. J., Goñi, E., Razquin, C., Serrano‐Martínez, M., Bes‐Rastrollo, M., Gea, A., Martínez‐Lapiscina, E. H., Nuñez‐Córdoba, J. M., Arroyo‐Azpa, C., García‐Pérez, L., Villanueva‐Tellería, J., Cortés‐Ugalde, F., Sagredo‐Arce, T., García de la Noceda‐Montoy, M. D., Vigata‐López, M. D., Arceiz‐Campo, M. T., Urtasun‐Samper, A., Gueto‐Rubio, M. V., Churio‐Beraza, B., Lamuela‐Raventós, R. M., Castellote‐Bargallo, A. I., Medina‐Remón, A., Tresserra‐Rimbau, A., Carrasco, P., Ortega‐ Azorín, C., Asensio, E. M., Osma, R., Barragán, R., Francés, F., Guillén, M., González, J. I., Saiz, C., Portolés, O., Giménez, F. J., Coltell, O., Guillem‐Saiz, P., Quiles, L., Pascual, V., Riera, C., Pages, M. A., Godoy, D., Carratalá‐Calvo, A., Martín‐Rillo, M. J., Llopis‐Osorio, E., Ruiz‐ Baixauli, J., Bertolín‐Muñoz, A., Salaverría, I., del Hierro, T., Algorta, J., Francisco, S., Alonso, A., San Vicente, J., Sanz, E., Felipe, I., Alonso Gómez, A., Loma‐Osorio, A., García‐Valdueza, M., Moñino, M., Proenza, A., Prieto, R., Frontera, G., Ginard, M., Fiol, F., Jover, A., García, J., Covas, M. I., Tello, S., Vila, J., Schröder, H., De la Torre, R., Muñoz‐Aguayo, D., Elosúa, R., Marrugat, J., Ferrer, M., Álvarez‐Pérez, J., DíazBenítez, E., Bautista‐Castaño, I., Maldonado‐Díaz, I., Sánchez‐Villegas, A., Castro, I., Henríquez, P., Ruano, C., Ortiz, A. P., Sarmiendo de la Fe, F., Simón‐García, C., Falcón‐Sanabria, I., Macías‐Gutiérrez, B., Santana‐Santana, A. J., Gomez‐Gracia, E., Fernández‐Crehuet, J., Benítez Pont, R., Bianchi Alba, M., Wärnberg, J., Gómez‐Huelgas, R., Martínez‐González, J., Velasco García, V., de Diego Salas, J., Baca Osorio, A., Gil Zarzosa, J., Sánchez Luque, J. J., Vargas López, E., Ruiz‐Gutierrez, V., Jurado Ruiz, E., Montero Romero, E., García García, M., Lapetra, J., Leal, M., Martínez, E., Santos, J. M., Ortega‐Calvo, M., Román, P., José García, F., Iglesias, P., Corchado, Y., Mayoral, E., Lama, C., Pintó, X., de la Cruz, E., Galera, A., Soler, Y., Trias, F., Sarasa, I., Padres, E., Figueras, R., Solanich, X., Pujol, R., Corbella, E., Cabezas, C., Vinyoles, E., Rovira, M. A., García, L., Flores, G., Verdú, J. M., Baby, P., Ramos, A., Mengual, L., Roura, P., Yuste, M. C., Guarner, A., Rovira, A., Santamaría, M. I., Mata, M., de Juan, C., Brau, A., Marti, A., Mitjavila, M. T., Portillo, M. P., Sáez, G., & Tur, J.
- Venue
- Journal of the American Heart Association
- Published
- 2016-01-13
- Volume
- 5
- Issue
- 1
- ISSN
- 2047-9980 (ISSN-L)
- OpenAlex
- W2252336474
- Cited by
- 178
- References
- 10
- FWCI
- 20.23
- Type
- journal article
- Language
- en
- Open access
- gold
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- CoChat. (2026). Citation check: Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study. https://app.cochat.ai/papers/10.1161/jaha.115.002543
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- Sala‐Vila, A., Guasch‐Ferré, M., Hu, F. B., Sánchez‐Tainta, A., Bulló, M., Serra‐Mir, M., López‐Sabater, C., Sorlí, J. V., Arós, F., Fiol, M., Muñoz, M. A., Serra‐Majem, L., Martínez, J. A., Corella, D., Fitó, M., Salas‐Salvadó, J., Martínez‐González, M. A., Estruch, R., Ros, E., . . . Tur, J. (2016). Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study. Journal of the American Heart Association. https://doi.org/10.1161/jaha.115.002543
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