Role of polyunsaturated fat in modifying cardiovascular risk associated with family history of cardiovascular disease: Pooled de novo results from 15 observational studies

Authors: LAGUZZI, FEDERICA - Karolinska Institute; AKESSON, AGNETA - Karolinska Institute; MARKLUND, MATTI - Johns Hopkins School Of Public Health; QIAN, FRANK - Boston University Medical School; GIGANTE, BRUNA - Karolinska Institute; BARTZ, TRACI - University Of Washington; BASSETT, JULIE - Cancer Council Victoria; BIRUKOV, ANNA - German Institute Of Human Nutrition; CAMPOS, HANNIA - Harvard School Of Public Health; HIRAKAWA, YOICHIRO - Kyushu University; IMAMURA, FUMIAKI - University Of Cambridge; JÄGER, SUSANNE - German Institute Of Human Nutrition; LANKINEN, MARIA - University Of Eastern Finland; MURPHY, RACHEL - University Of British Columbia; SENN, MACKENZIE - Children'S Nutrition Research Center (CNRC); TANAKA, TOSHIKO - National Institute On Aging (NIA, NIH); TINTLE, NATHAN - Fatty Acid Research Institute; VIRTANEN, JYRKI - University Of Eastern Finland; YAMAGISHI, KAZUMASA - University Of Tsukuba; ALLISON, MATTHEW - University Of California, San Diego; BROUWER, INGEBORG - Vrije University; DE FAIRE, ULF - Karolinska Institute; EIRIKSDOTTIR, GUDNY - Icelandic Heart Association; FERRUCCI, LUIGI - National Institute On Aging (NIA, NIH); FOROUHI, NITA - University Of Cambridge; GELEIJNSE, JOHANNA - Wageningen University; HODGE, ALLISON - Cancer Council Victoria; KIMURA, HITOMI - University Of Tsukuba; LAAKSO, MARKKU - University Of Eastern Finland; RISERUS, ULF - Uppsala University; VAN WESTING, ANNIEK - Wageningen University; BANDINELLI, STEFANIA - Azienda Sanitaria Di Firenze; BAYLIN, ANA - University Of Michigan; GILES, GRAHAM - Cancer Council Victoria; GUDNASON, VILMUNDUR - Icelandic Heart Association; ISO, HIROYASU - University Of Osaka; LEMAITRE, ROZENN - University Of Washington; NINOMIYA, TOSHIHARU - Kyushu University; POST, WENDY - Johns Hopkins School Of Public Health; PSATY, BRUCE - University Of Washington; SALONEN, JUKKA - University Of Helsinki; SCHULZE, MATTIAS - German Institute Of Human Nutrition; TSAI, MICHAEL - University Of Minnesota; UUSITUPA, MATTI - University Of Eastern Finland; WAREHAM, NICHOLAS - University Of Cambridge; OH, SEUNG - Seoul National University; WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); HARRIS, WILLIAM - Fatty Acid Research Institute; SISCOVICK, DAVID - New York Academy Of Medicine; MOZAFFARIAN, DARIUS - Friedman School At Tufts; LEANDER, KARIN - Karolinska Institute

Submitted to: Circulation
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/25/2023
Publication Date: 12/4/2023
Citation: Laguzzi, F., Akesson, A., Marklund, M., Qian, F., Gigante, B., Bartz, T.M., Bassett, J.K., Birukov, A., Campos, H., Hirakawa, Y., Imamura, F., Jäger, S., Lankinen, M., Murphy, R.A., Senn, M., Tanaka, T., Tintle, N., Virtanen, J.K., Yamagishi, K., Allison, M., Brouwer, I.A., De Faire, U., Eiriksdottir, G., Ferrucci, L., Forouhi, N.G., Geleijnse, J.M., Hodge, A.M., Kimura, H., Laakso, M., Riserus, U., Van Westing, A.C., Bandinelli, S., Baylin, A., Giles, G.G., Gudnason, V., Iso, H., Lemaitre, R.N., Ninomiya, T., Post, W.S., Psaty, B.M., Salonen, J.T., Schulze, M., Tsai, M.Y., Uusitupa, M., Wareham, N.J., Oh, S.W., Wood, A.C., Harris, W.S., Siscovick, D.S., Mozaffarian, D., Leander, K. 2023. Role of polyunsaturated fat in modifying cardiovascular risk associated with family history of cardiovascular disease: Pooled de novo results from 15 observational studies. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.123.065530.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.123.065530

Interpretive Summary: Polyunsaturated fats (PUFAs) are a type of fat found in the diet, which have been shown to convey many health benefits, including protection from cardiovascular disease (CVD). Individuals with a family risk of CVD are at a higher risk of developing CVD than those without a family risk. The current study investigated whether levels of PUFAs in the blood also modify the risk of future cardiovascular events in individuals with a family history of CVD. In analysis of data from a large number of studies, collected from all over the world, levels of PUFA in the blood were shown to be associated with a lower risk of adverse cardiovascular events in those with family history. Furthermore, the reduction in risk was stronger for those with versus without a family history of CVD. However, the level of protection was specific to the type of PUFA studied. These results suggest that recommendations to consume food rich in certain PUFAs, such as oily fish, should perhaps be emphasized in individuals with a family history of CVD.

Technical Abstract: It is unknown whether dietary intake of polyunsaturated fatty acids (PUFA) modifies the cardiovascular disease (CVD) risk associated with a family history of CVD. We assessed interactions between biomarkers of low PUFA intake and a family history in relation to long-term CVD risk in a large consortium. Blood and tissue PUFA data from 40,885 CVD-free adults were assessed. PUFA levels <=25th percentile were considered to reflect low intake of linoleic, alpha-linolenic, and eicosapentaenoic/docosahexaenoic acids (EPA/DHA). Family history was defined as having >=1 first-degree relative who experienced a CVD event. Relative risks with 95% CI of CVD were estimated using Cox regression and meta-analyzed. Interactions were assessed by analyzing product terms and calculating relative excess risk due to interaction. After multivariable adjustments, a significant interaction between low EPA/DHA and family history was observed (product term pooled RR, 1.09 [95% CI, 1.02-1.16]; P=0.01). The pooled relative risk of CVD associated with the combined exposure to low EPA/DHA, and family history was 1.41 (95% CI, 1.30-1.54), whereas it was 1.25 (95% CI, 1.16-1.33) for family history alone and 1.06 (95% CI, 0.98-1.14) for EPA/DHA alone, compared with those with neither exposure. The relative excess risk due to interaction results indicated no interactions. A significant interaction between biomarkers of low EPA/DHA intake, but not the other PUFA, and a family history was observed. This novel finding might suggest a need to emphasize the benefit of consuming oily fish for individuals with a family history of CVD.