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Intake of marine and plant-derived n-3 fatty acids and development of atherosclerotic cardiovascular disease in the Danish Diet, Cancer and Health cohort

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Abstract

Purpose

The objective of this study was to investigate the association between intake of seafood and plant-derived n-3 polyunsaturated fatty acids (PUFA) and development of total atherosclerotic cardiovascular disease (ASCVD) and acute major ischemic events.

Methods

A total of 53,909 men and women were enrolled between 1993 and 1997 into the Danish Diet, Cancer and Health cohort and followed through nationwide Danish registries for development of total ASCVD defined as a first registration of myocardial infarction, peripheral artery disease, or ischemic stroke due to large artery atherosclerosis or small-vessel occlusion. At recruitment, the intake of the major marine n-3 PUFA, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the plant-derived n-3 PUFA, alpha-linolenic acid (ALA), was assessed using a validated food frequency questionnaire. Statistical analyses were conducted using sex-stratified multivariable Cox proportional hazard regression models.

Results

During a median of 13.5 years of follow-up, 3958 participants developed ASCVD including 3270 patients with an acute major ischemic event. In multivariable analyses including adjustment for established risk factors, we found no associations for intake of ALA, but indications of inverse associations between intake of EPA, DHA and EPA + DHA and the rate of total ASCVD and acute major ischemic events.

Conclusions

A high intake of marine n-3 PUFA was associated with a lower risk of total ASCVD and acute major ischemic events, whereas no association could be demonstrated for the plant-derived ALA.

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Data availability

Data are available from the Diet, Cancer and Health Institutional Data Access (https://www.cancer.dk/research/dcrc-research/diet-cancer-and-health/). To access data, an application must be approved by the Scientific Board. Furthermore, as data contain potentially identifying or sensitive information, access to data has to be registered and approved by The Danish Data Protection Agency and/or a Health Research Ethics Committee.

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Funding

The Danish Cancer Society funded the Diet, Cancer and Health cohort. The current study was financially supported by Health Research Foundation of North Denmark Region. The funding agency had no role in the current research.

Author information

Authors and Affiliations

  1. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark

    Christian S. Bork, Stine K. Venø & Erik B. Schmidt

  2. Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark

    Søren Lundbye-Christensen

  3. Department of Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark

    Anne N. Lasota

  4. Danish Cancer Society Research Center, Copenhagen, Denmark

    Anne Tjønneland

  5. Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Anne Tjønneland

  6. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Erik B. Schmidt

  7. Department of Public Health, Aarhus University, Aarhus, Denmark

    Kim Overvad

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  1. Christian S. Bork
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Contributions

The authors’ responsibilities were as follows; AT and KO: conceived the study concept and contributed to the data acquisition; CSB: contributed to the study design and planning of the statistical analyses, interpretation of data and conducted the statistical analyses, prepared the tables and figures, and wrote the manuscript; SKV, ANL, SLC, EBS, and KO: contributed to the study design and planning of the statistical analyses, interpretation of data, and writing of the manuscript; SLC: supervised the conduct of the statistical analyses; AT: contributed to the critical interpretation of the manuscript. CSB: had the primary responsibility for the final content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Christian S. Bork.

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Bork, C.S., Lundbye-Christensen, S., Venø, S.K. et al. Intake of marine and plant-derived n-3 fatty acids and development of atherosclerotic cardiovascular disease in the Danish Diet, Cancer and Health cohort. Eur J Nutr 62, 1389–1401 (2023). https://doi.org/10.1007/s00394-022-03081-w

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