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00925njm 22002777a 4500 dc Sala-Vila, Aleix author Guasch-Ferre, Marta author Hu, Frank B author Sanchez-Tainta, Ana author bullo, Monica author Serra-Mir, Merce author Lopez-Sabater, Carmen author Sorli, Jose V author Aros, Fernando author Fiol Sala, Miquel author Munoz, Miguel A author Serra-Majem, Luis author Alfredo Martinez, J author Corella, Dolores author Fito, Montserrat author Salas-Salvado, Jordi author Martinez-Gonzalez, Miguel A author Estruch, Ramon author Ros, Emilio author PREDIMED Investigators author 2016-01 Background-Epidemiological evidence suggests a cardioprotective role of a-linolenic acid (ALA), a plant-derived x-3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine x-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 PREvencion con DIeta MEDiterranea (PREDIMED) trial. Multivariable-adjusted Cox regressionmodels were fitted to estimate hazard ratios. ALA intake correlated towalnut 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 formeeting ALArecommendation (n= 1615, 22.4%) were 0.72 (95% CI 0.56-0.92) for all-causemortality and 0.95 (95% CI 0.58-1.57) for fatal cardiovascular disease. The hazard ratios formeeting 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-causemortality, 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. Sala-Vila A, Guasch-Ferre M, Hu FB, Sanchez-Tainta A, Bullo M, Serra-Mir M, et al. Dietary alpha-Linolenic Acid, Marine omega-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvencion con Dleta MEDiterranea (PREDIMED) Study. J Am Heart Assoc. 2016 Jan;5(1):e002543. 10.1161/JAHA.115.002543 2047-9980 Journal of the American Heart Association http://hdl.handle.net/20.500.13003/17184 26813890 L613254300 2-s2.0-84998579388 http://hdl.handle.net/20.500.12105/20238 371282800036 Fatty acid Nutrition Sudden cardiac death Dietary alpha-Linolenic Acid, Marine omega-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvencion con Dleta MEDiterranea (PREDIMED) Study