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Title: Plasma phospholipid fatty acids and coronary heart disease risk: a matched case-control study within the women's health initiative observational study

Author
item LIU, QING - Brown University
item MATTHAN, NIRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item MANSON, JOANN - Brigham & Women'S Hospital
item HOWARD, BARBARA - Georgetown University
item TINKER, LESLEY - Fred Hutchinson Cancer Research Center
item NEUHOUSER, MARIAN - Fred Hutchinson Cancer Research Center
item VAN HORN, LINDA - Northwestern University
item ROSSOUW, JACQUES - National Heart, Lung And Blood Institute(NHLBI, NIH)
item ALLISON, MATHEW - University Of California
item MARTIN, LISA - George Washington University
item LI, WENJUN - University Of Massachusetts
item SNETSELAAR, LINDA - University Of Iowa
item WANG, LU - Brigham & Women'S Hospital
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item EATON, CHARLES - Memorial Hospital Of Rhode Island

Submitted to: Nutrients
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/17/2019
Publication Date: 7/21/2019
Citation: Liu, Q., Matthan, N.R., Manson, J.E., Howard, B.V., Tinker, L.F., Neuhouser, M.L., Van Horn, L.V., Rossouw, J.E., Allison, M.A., Martin, L.W., Li, W., Snetselaar, L.G., Wang, L., Lichtenstein, A.H., Eaton, C.B. 2019. Plasma phospholipid fatty acids and coronary heart disease risk: a matched case-control study within the women's health initiative observational study. Nutrients. 11(7):1672. https://doi.org/10.3390/nu11071672.
DOI: https://doi.org/10.3390/nu11071672

Interpretive Summary: The association of dietary fatty acids and coronary heart disease has been called into question. Dietary trials have shown that replacing saturated fats with unsaturated fats has a favorable effect on lipoprotein concentrations. The effect of the dietary replacement is reflected in plasma phospholipid fatty acid profiles. Analyses were conducted to assess the effect of substituting different types of fatty acids on the association between phospholipid fatty acids and coronary heart disease risk, both directly and by estimating the theoretical effects of plasma phospholipid fatty acid substitutions. We performed a matched case-control study of 2,428 postmenopausal women nested in the Women's Health Initiative observational study. Plasma phospholipid long-chain saturated fatty acids were associated with increased coronary heart disease risk while n-3 polyunsaturated fatty acids were associated with decreased risk. No significant associations were observed for very-long-chain saturated fatty acids, monounsaturated fatty acids, n-6 polyunsaturated fatty acids and trans fatty acids. Substituting 1 mol% long-chain saturated fatty acids with an equivalent proportion of monounsaturated fatty acids, n-3 polyunsaturated fatty acids, or n-6 polyunsaturated fatty acids was associated with lower coronary heart disease risk. These findings suggest that plasma phospholipid long-chain saturated fatty acids were associated with an increased coronary heart disease risk. A dietary substitution of foods high in saturated animal fats with foods high in unsaturated fats may reduce coronary heart disease risk among postmenopausal women.

Technical Abstract: Background and Aims - The association of dietary fatty acids (FAs) and coronary heart disease (CHD) has been called into question. Dietary trials have shown that replacing saturated fats with unsaturated fats can significantly change plasma FAs. Thus, substitutions of plasma FAs of different types are feasible through dietary changes. We evaluated the association of plasma phospholipid fatty acids (PL-FAs) with CHD risk, both directly and by estimating the theoretical effects of plasma substitution of various FAs for each other. Methods - We performed a matched case-control study of 2428 postmenopausal women nested in the Women's Health Initiative observational study. Plasma PL-FAs were measured using gas chromatography and expressed as molar percentage (mol%). Multivariable conditional logistic regression was used to calculate odds ratios (95% CIs) for CHD associated with 1 mol% change in PL-FAs. Results - Plasma PL long-chain saturated fatty acid (SFA) was associated with increased CHD risk while n-3 polyunsaturated fatty acid (PUFA) was associated with decreased risk. No significant associations were observed for very-long-chain SFA, monounsaturated fatty acid (MUFA), n-6 PUFA and trans fatty acid (TFA). Substituting 1 mol% long-chain SFA with an equivalent proportion of MUFA, n-3 PUFA, or n-6 PUFA were associated with lower CHD risk. Conclusion - Plasma PL long-chain SFA was associated with an increased CHD risk. A switch of diet by substituting foods high in saturated animal fats with foods high in unsaturated fats that results in plasma substations may be beneficial to CHD among postmenopausal women.