Journal
JOURNAL OF THE AMERICAN HEART ASSOCIATION
Volume 3, Issue 4, Pages -Publisher
WILEY
DOI: 10.1161/JAHA.114.000914
Keywords
cardiovascular diseases; coronary disease; nutrition; total mortality; trans-fatty acids
Categories
Funding
- National Heart, Lung, and Blood Institute (NHLBI)
- Office of Dietary Supplements, National Institutes of Health [2R01-HL-085710, R01-HL-085710]
- NHLBI [HHSN268201200036C, HHSN268200800007C, N01 HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, HL080295]
- National Institute of Neurological Disorders and Stroke
- National Institute on Aging [AG023629]
- Medical Research Council Epidemiology Unit Core Support [MC_UU_12015/5]
- Medical Research Council [MC_UU_12015/5, MC_UP_A100_1003] Funding Source: researchfish
- MRC [MC_UU_12015/5, MC_UP_A100_1003] Funding Source: UKRI
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Background-While self-reported trans-fatty acid (TFA) consumption is linked to coronary heart disease (CHD), relationships between objective biomarkers of TFA subtypes (t-16:1n9, total t-18:1, and cis/trans-(c/t-), t/c- and t/t-18:2) and cardiovascular disease (CVD) or total mortality are not well established. Methods and Results-We evaluated 2742 adults in the Cardiovascular Health Study, aged 74+/-5 years and free of prevalent CVD, with plasma phospholipid TFA measures in 1992. Incident fatal and nonfatal CHD events, CVD and non-CVD mortality, and total mortality were centrally adjudicated through 2010. Risks were assessed using Cox proportional hazards. During 31 494 person-years, 1735 total deaths and 639 total CHD events occurred. In the multivariate model including mutual adjustment for the 5 TFA subtypes, circulating t/t-18:2 was associated with higher total mortality (extreme quintile hazard ratio (HR)=1.23, 95% CI=1.04 to 1.44, P-trend=0.01), CVD mortality (HR=1.40, 95% CI=1.05 to 1.86, P-trend=0.02), and total CHD (HR=1.39, 95% CI=1.06 to 1.83, P-trend=0.01). t/c-18:2 was positively related to total mortality (HR=1.19, P-trend=0.05), total CHD (HR=1.67, P-trend=0.002), and nonfatal CHD (HR=2.06, P-trend=0.002) after mutual adjustment; these associations were insignificant without mutual adjustment. Neither t-16:1n9 nor t-18:1 was significantly associated with total mortality or CVD, nor was c/t-18:2 if we excluded early cases. Conclusions-Among circulating TFAs, t/t-18:2 was most adversely associated with total mortality, mainly due to the increased risk of CVD. t/c-18:2 was also positively associated with total mortality and CHD, but only after adjustment for other TFAs. These results highlight the need for further investigation of dietary sources, nondietary determinants, and health effects of specific TFA subtypes, especially t-18:2 isomers.
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