Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-10T11:36:17.494Z Has data issue: false hasContentIssue false

Dietary fatty acids and CHD: from specific recommendations to dietary patterns

Published online by Cambridge University Press:  07 January 2021

Jacques Delarue*
Affiliation:
Department of Nutritional Sciences and Laboratory of Human Nutrition, ER 7479 SPURBO (Soins primaires, Santé publique, Registre des cancers de Bretagne Occidentale), University Hospital/Faculty of Medicine/University of Brest, France
*
Corresponding author: Professor Jacques Delarue, fax +33 2 98 34 78 82, email jaques.delarue@univ-brest.fr

Abstract

Several countries have issued dietary recommendations about total and specific fatty acid (FA) intake for the prevention of CHD. For many years until today, controversies have existed especially about the deleterious effect or not of SFA, and the protective effect or not of n-3 PUFA, so that some authors have criticised these recommendations. There are many reasons for these controversies, including the different conclusions of prospective cohort studies compared with randomised clinical trials (RCT), and the contradictory conclusions of meta-analyses depending on the quality, number and type of studies included. The interrelationships between different FA in the diet make it difficult to analyse the specific effect of a particular class of FA on CHD. Furthermore, based on clinical practice and effectiveness of population-based prevention, it is very difficult at the individual level to assess in personal dietary intake the actual percentage and/or amount of SFA contained in each meal or consumed daily/weekly. In this critical narrative review, we try to answer the question of whether it would not be more relevant, in 2020, to promote dietary patterns, rather than FA intake recommendations. We critically analyse past and recent data on the association of FA with CHD, then propose that the Mediterranean diet and Japanese diet should be revitalised for Westerners and Asian populations, respectively. This does not exclude the usefulness of continuing research about effects of FA towards CHD, and accepting that what seems true today might be revised, at least partially tomorrow.

Type
Review Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Nutrition Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This article was originally published with an omission in the author’s affiliation. The affiliation has been corrected and the online PDF and HTML versions updated.

References

Nestle, M (2018) Perspective: Challenges and controversial issues in the dietary guidelines for Americans, 1980–2015. Adv Nutr 9, 148150.CrossRefGoogle ScholarPubMed
Harcombe, Z, Baker, JS, DiNicolantonio, JJ, et al. (2016) Evidence from randomised controlled trials does not support current dietary fat guidelines: a systematic review and meta-analysis. Open Heart 3, e000409.CrossRefGoogle Scholar
Keys, A, Menotti, A, Karvonen, MJ, et al. (1986) The diet and 15-year death rate in the Seven Countries Study. Am J Epidemiol 124, 903915.CrossRefGoogle ScholarPubMed
Kromhout, D, Menotti, A, Bloemberg, B, et al. (1995) Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study. Prev Med 24, 308315.CrossRefGoogle ScholarPubMed
Menotti, A, Kromhout, D, Blackburn, H, et al. (1999) Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. The Seven Countries Study Research Group. Eur J Epidemiol 15, 507515.CrossRefGoogle Scholar
Kromhout, D, Menotti, A, Alberti-Fidanza, A, et al. (2018) Comparative ecologic associations of saturated fat, sucrose, food groups, and a Mediterranean food pattern score to 50-year coronary heart disease mortality rates among 16 cohorts of the Seven Countries Study. Eur J Clin Nutr 72, 11031110.CrossRefGoogle Scholar
Bang, HO, Dyerberg, J & Nielsen, AB (1971) Plasma lipid and lipoprotein pattern in Greenlandic West-coast Eskimos. Lancet i, 11431145.CrossRefGoogle Scholar
Dyerberg, J, Bang, HO & Hjorne, N (1975) Fatty acid composition of the plasma lipids in Greenland Eskimos. Am J Clin Nutr 28, 958966.CrossRefGoogle ScholarPubMed
Bang, HO, Dyerberg, J & Hjøorne, N (1976) The composition of food consumed by Greenland Eskimos. Acta Med Scand 200, 6973.CrossRefGoogle ScholarPubMed
Bang, HO, Dyerberg, J & Sinclair, HM (1980) The composition of the Eskimo food in north western Greenland. Am J Clin Nutr 33, 26572661.CrossRefGoogle ScholarPubMed
Dyerberg, J & Bang, HO (1979) Haemostatic function and platelet polyunsaturated fatty acids in Eskimos. Lancet ii, 433435.CrossRefGoogle Scholar
Bang, HO (1990) Lipid research in Greenland: preventive and therapeutic consequences. Scand J Soc Med 18, 37.CrossRefGoogle ScholarPubMed
Dyerberg, J & Bang, HO (1982) A hypothesis on the development of acute myocardial infarction in Greenlanders. Scand J Clin Lab Invest Suppl 161, 713.CrossRefGoogle ScholarPubMed
Nelson, AM (1972) Diet therapy in coronary disease. Effect on mortality of high-protein, high seafood, fat controlled diet. Geriatrics 27, 27103.Google ScholarPubMed
Bang, HO & Dyerberg, J (1981) Personal reflections on the incidence of ischaemic heart disease in Oslo during the Second World War. Acta Med Scand 210, 235248.Google ScholarPubMed
Hirai, A, Hamazaki, T, Terano, T, et al. (1980) Eicosapentaenoic acid and platelet function in Japanese. Lancet ii, 11321133.CrossRefGoogle Scholar
Sho, H (2001) History and characteristics of Okinawan longevity food. Asia Pac J Clin Nutr 10, 159164.CrossRefGoogle ScholarPubMed
Toyokawa, H (1796) Public Nutrition. Tokyo: Koseikan Publisher.Google Scholar
Nagata, N (1963) Elderly Population of Okinawa. Tokyo: Chukoron Jigyo.Google Scholar
United States Department of the Office of the Civil Administrator of the Ryukyu Islands: Records of Health, Education and Welfare (1949) U.S. Occupation Headquarters, World War II. Record Group 260·12.5. National Archives at College Park, 8601 Adelphi Road, College Park, MD 20740-6001.Google Scholar
Division of Health, Labor and Welfare, Okinawa Prefectural Government (1976) Health and Welfare Dataset 1880–1976. Okinawa: Okinawa Prefectural Government.Google Scholar
Japanese Ministry of Health, Labour and Welfare (2017) Table 5. Life expectancies at birth in some countries. https://www.mhlw.go.jp/english/database/db-hw/lifetb18/dl/lifetb18-03.pdf (accessed August 2020).Google Scholar
Wong, CX, Brown, A, Lau, DH, et al. (2019) Epidemiology of sudden cardiac death: global and regional perspectives. Heart Lung Circ 28, 614.CrossRefGoogle ScholarPubMed
Marmot, MG, Syme, SL, Kagan, A, et al. (1975) Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of coronary and hypertensive heart disease and associated risk factors. Am J Epidemiol 102, 514525.CrossRefGoogle ScholarPubMed
Benfante, R (1992) Studies of cardiovascular disease and cause-specific mortality trends in Japanese-American men living in Hawaii and risk factor comparisons with other Japanese populations in the Pacific region: a review. Hum Biol 64, 791805.Google ScholarPubMed
Tada, N, Maruyama, C, Koba, S, et al. (2011) Japanese dietary lifestyle and cardiovascular disease. J Atheroscler Thromb 18, 723734.CrossRefGoogle ScholarPubMed
Mozaffarian, D, Katan, MB, Ascherio, A, et al (2006) Trans fatty acids and cardiovascular disease. N Engl J Med 354, 16011613.CrossRefGoogle ScholarPubMed
Wang, DD, Li, Y, Chiuve, SE, et al. (2016) Association of specific dietary fats with total and cause-specific mortality. JAMA Intern Med 176, 11341145.CrossRefGoogle ScholarPubMed
Zhu, Y, Bo, Y & Liu, Y (2019) Dietary total fat, fatty acids intake, and risk of cardiovascular disease: a dose–response meta-analysis of cohort studies. Lipids Health Dis 18, 91.CrossRefGoogle ScholarPubMed
World Health Organization (2018) REPLACE trans fat: an action package to eliminate industrially-produced trans-fatty acids. https://www.who.int/docs/default-source/documents/replace-transfats/replace-action package.pdf (accessed August 2020).Google Scholar
United States, Food & Drug, Administration (2018) Final determination regarding partially hydrogenated oils (removing trans fat). https://www.fda.gov/food/food-additives-petitions/final-determination-regarding-partially-hydrogenated-oils-removing-trans-fat (accessed August 2020).Google Scholar
Zong, G, Li, Y, Wanders, AJ, et al. (2016) Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies. BMJ 355, i5796.Google ScholarPubMed
Neelakantan, N, Seah, JYH & van Dam, RM (2020) The effect of coconut oil consumption on cardiovascular risk factors: a systematic review and meta-analysis of clinical trials. Circulation 141, 803814.CrossRefGoogle ScholarPubMed
Wu, JHY, Micha, R & Mozaffarian, D (2019) Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes. Nat Rev Cardiol 6, 581601.CrossRefGoogle Scholar
Dehghan, M, Mente, A, Zhang, X, et al. (2017) Prospective Urban Rural Epidemiology (PURE) study investigators. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 390, 20502062.CrossRefGoogle Scholar
Zhuang, P, Zhang, Y, He, W, et al. (2019) Dietary fats in relation to total and cause-specific mortality in a prospective cohort of 521 120 individuals with 16 years of follow-up. Circ Res 124, 757768.CrossRefGoogle Scholar
Skeaff, CM & Miller, J (2009) Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab 55, 173201.CrossRefGoogle ScholarPubMed
Siri-Tarino, PW, Sun, Q, Hu, FB, et al. (2010) Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 91, 535546.CrossRefGoogle ScholarPubMed
Chowdhury, R, Warnakula, S, Kunutsor, S, et al. (2014) Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med 160, 398406. Erratum in: Ann Intern Med (2014), 160, 658.CrossRefGoogle Scholar
Bittman, M (2014) Butter Is Back, The New York Times. https://www.nytimes.com/2014/03/26/opinion/bittman-butter-is-back.html (accessed August 2020).Google Scholar
Walsh, B (2014). Eat Butter. Scientists labelled fat the enemy. Why they were wrong. Time, vol. 183, no. 24, 23 June 2014. https://time.com/magazine/us/2863200/june-23rd-2014-vol-183-no-24-u-s/ (accessed August 2020).Google Scholar
Li, Y, Hruby, A, Bernstein, AM, et al. (2015) Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease: a prospective cohort study. J Am Coll Cardiol 66, 15381548.CrossRefGoogle ScholarPubMed
Chen, M, Li, Y, Sun, Q, et al. (2016) Dairy fat and risk of cardiovascular disease in 3 cohorts of US adults. Am J Clin Nutr 104, 12091217.CrossRefGoogle ScholarPubMed
Prentice, RL, Aragaki, AK, Van Horn, L, et al. (2017) Low-fat dietary pattern and cardiovascular disease: results from the Women’s Health Initiative randomized controlled trial. Am J Clin Nutr 106, 3543.CrossRefGoogle ScholarPubMed
Mozaffarian, D, Micha, R & Wallace, S (2010) Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 23, e1000252.CrossRefGoogle Scholar
Hooper, L, Martin, N, Abdelhamid, A, et al. (2015) Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev, issue 6, CD011737.CrossRefGoogle Scholar
Hegsted, DM, McGandy, RB, Myers, ML, et al. (1965) Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr 17, 281295.CrossRefGoogle ScholarPubMed
Mensink, RP, Zock, PL, Kester, AD, et al. (2003) Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 77, 11461155.CrossRefGoogle ScholarPubMed
Hu, FB, Stampfer, MJ, Manson, JE, et al. (1997) Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med 337, 14911499.CrossRefGoogle ScholarPubMed
Oh, K, Hu, FB, Manson, JE, et al. (2005) Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the Nurses’ Health Study. Am J Epidemiol 161, 672679.CrossRefGoogle ScholarPubMed
Guasch-Ferré, M, Babio, N, Martínez-González, MA, et al. (2015) PREDIMED Study Investigators. Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am J Clin Nutr 102, 15631573.CrossRefGoogle Scholar
Jakobsen, MU, O’Reilly, EJ, Heitmann, BL, et al. (2009) Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 89, 14251432.CrossRefGoogle ScholarPubMed
Schwingshackl, L & Hoffmann, G (2014) Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression. BMJ Open 4, e004487.CrossRefGoogle ScholarPubMed
Schwingshackl, L & Hoffmann, G (2014) Monounsaturated fatty acids, olive oil and health status: a systematic review and meta-analysis of cohort studies. Lipids Health Dis 13, 154.CrossRefGoogle ScholarPubMed
Martínez-González, MA, Dominguez, LJ & Delgado-Rodríguez, M (2014) Olive oil consumption and risk of CHD and/or stroke: a meta-analysis of case-control, cohort and intervention studies. Br J Nutr 112, 248259.CrossRefGoogle ScholarPubMed
Dolecek, T (1992) Epidemiological evidence of relationships between dietary polyunsaturated fatty acids and mortality in the multiple risk factor intervention trial. Proc Soc Exp Biol Med 200, 177182.CrossRefGoogle ScholarPubMed
Ascherio, A, Rimm, EB, Giovannucci, EL, et al. (1996) Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. Br Med J 313, 8490.CrossRefGoogle ScholarPubMed
Mozaffarian, D, Ascherio, A, Hu, FB, et al. (2005) Interplay between different polyunsaturated fatty acids and risk of coronary heart disease in men. Circulation 111, 157164.CrossRefGoogle ScholarPubMed
Pietinen, P, Ascherio, A, Korhonen, P, et al. (1997) Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Epidemiol 145, 876887.CrossRefGoogle Scholar
Koh, AS, Pan, A, Wang, R, et al. (2015) The association between dietary omega-3 fatty acids and cardiovascular death: the Singapore Chinese Health Study. Eur J Prev Cardiol 22, 364372.CrossRefGoogle ScholarPubMed
Hu, FB, Stampfer, MJ, Manson, JE, et al. (1999) Dietary intake of α-linolenic acid and risk of fatal ischemic heart disease among women. Am J Clin Nutr 69, 890897.CrossRefGoogle ScholarPubMed
Albert, CM, Oh, K, Whang, W, et al. (2005) Dietary α-linolenic acid intake and risk of sudden cardiac death and coronary heart disease. Circulation 112, 32323238.CrossRefGoogle ScholarPubMed
de Goede, J, Verschuren, WM, Boer, JM, et al. (2011) Alpha-linolenic acid intake and 10-year incidence of coronary heart disease and stroke in 20,000 middle-aged men and women in the Netherlands. PLoS ONE 6, e17967.CrossRefGoogle ScholarPubMed
Vedtofte, MS, Jakobsen, MU, Lauritzen, L, et al. (2014) Association between the intake of α-linolenic acid and the risk of CHD. Br J Nutr 112, 735743.CrossRefGoogle ScholarPubMed
Oomen, CM, Ocké, MC, Feskens, EJ, et al. (2001) α-Linolenic acid intake is not beneficially associated with 10-y risk of coronary artery disease incidence: the Zutphen Elderly Study. Am J Clin Nutr 74, 457463.CrossRefGoogle Scholar
Fretts, AM, Mozaffarian, D, Siscovick, DS, et al. (2014) Plasma phospholipid and dietary α-linolenic acid, mortality, CHD and stroke: the Cardiovascular Health Study. Br J Nutr 112, 12061213.CrossRefGoogle ScholarPubMed
de Oliveira Otto, MC, Wu, JH, Baylin, A, et al. (2013) Circulating and dietary omega-3 and omega-6 polyunsaturated fatty acids and incidence of CVD in the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2, e000506.CrossRefGoogle ScholarPubMed
Sala-Vila, A, Guasch-Ferré, M, Hu, FB, et al. (2016) Dietary α-linolenic acid, marine ω-3 fatty acids, and mortality in a population with high fish consumption: findings from the PREvención con DIeta MEDiterránea (PREDIMED) study. J Am Heart Assoc 5, e002543.CrossRefGoogle Scholar
Bork, CS, Jakobsen, MU, Lundbye-Christensen, S, et al. (2016) Dietary intake and adipose tissue content of α-linolenic acid and risk of myocardial infarction: a Danish cohort study. Am J Clin Nutr 104, 4148.CrossRefGoogle ScholarPubMed
Campos, H, Baylin, A & Willett, WC (2008) α-Linolenic acid and risk of nonfatal acute myocardial infarction. Circulation 118, 339345.CrossRefGoogle ScholarPubMed
Guallar, E, Aro, A, Jiménez, FJ, et al. (1999) Omega-3 fatty acids in adipose tissue and risk of myocardial infarction: the EURAMIC study. Arterioscler Thromb Vasc Biol 19, 11111118.CrossRefGoogle ScholarPubMed
Pan, A, Chen, M, Chowdhury, R, et al. (2012) α-Linolenic acid and risk of cardiovascular disease: a systematic review and meta-analysis. Am J Clin Nutr 96, 12621273.CrossRefGoogle ScholarPubMed
Del Gobbo, LC, Imamura, F, Aslibekyan, S, et al. (2016) Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Fatty Acids and Outcomes Research Consortium (FORCe). ω-3 Polyunsaturated fatty acid biomarkers and coronary heart disease: pooling project of 19 cohort studies. JAMA Intern Med 176, 11551166.CrossRefGoogle ScholarPubMed
Balk, EM & Lichtenstein, AH (2017) Omega-3 fatty acids and cardiovascular disease: summary of the 2016 Agency of Healthcare Research and Quality evidence review. Nutrients 9, 865.CrossRefGoogle ScholarPubMed
Wei, J, Hou, R, Xi, Y, et al. (2018) The association and dose–response relationship between dietary intake of α-linolenic acid and risk of CHD: a systematic review and meta-analysis of cohort studies. Br J Nutr 119, 8389.CrossRefGoogle ScholarPubMed
Abdelhamid, AS, Brown, TJ, Brainard, JS, et al. (2020) Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Databas Syst Rev, issue 3, CD003177.CrossRefGoogle Scholar
Rose, GA, Thomson, WB & Williams, RT (1965) Corn oil in treatment of ischaemic heart disease. Br Med J i, 15311533.CrossRefGoogle Scholar
Leren, P (1970) The Oslo Diet-Heart Study. Eleven-year report. Circulation 42, 935942.CrossRefGoogle ScholarPubMed
Turpeinen, O (1979) Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes. Circulation 59, 17.Google ScholarPubMed
Frantz, ID Jr, Dawson, EA, Ashman, PL, et al. (1989) Test of effect of lipid lowering by diet on cardiovascular risk. The Minnesota Coronary Survey. Arteriosclerosis 9, 129135.Google ScholarPubMed
Ramsden, CE, Zamora, D, Majchrzak-Hong, S, et al. (2016) Re-evaluation of the traditional diet–heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968–73). BMJ 353, i1246.Google ScholarPubMed
Ramsden, CE, Zamora, D, Leelarthaepin, B, et al. (2013) Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ 346, e8707.CrossRefGoogle ScholarPubMed
Ramsden, CE, Hibbeln, JR, Majchrzak, SF, et al. (2010) n-6 Fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. Br J Nutr 104, 15861600.CrossRefGoogle Scholar
Farvid, MS, Ding, M, Pan, A, et al. (2014) Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta-analysis of prospective cohort studies. Circulation 130, 15681578.CrossRefGoogle ScholarPubMed
Hamley, S (2017) The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomized controlled trials. Nutr J 16, 30.CrossRefGoogle Scholar
Hooper, L, Al-Khudairy, L, Abdelhamid, AS, et al. (2018) Omega-6 fats for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev, issue 11, CD011094.Google Scholar
Marklund, M, Wu, JHY, Imamura, F, et al. (2019) Biomarkers of dietary omega-6 fatty acids and incident cardiovascular disease and mortality. Circulation 139, 24222436.CrossRefGoogle ScholarPubMed
Li, J, Guasch-Ferré, M, Li, Y, et al. (2020) Dietary intake and biomarkers of linoleic acid and mortality: systematic review and meta-analysis of prospective cohort studies. Am J Clin Nutr 112, 150167.CrossRefGoogle ScholarPubMed
Hu, FB, Bronner, L, Willett, WC, et al. (2002) Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 287, 18151821.CrossRefGoogle ScholarPubMed
Sun, Q, Ma, J, Campos, H, Rexrode, et al. (2008) Blood concentrations of individual long-chain n-3 fatty acids and risk of nonfatal myocardial infarction. Am J Clin Nutr 88, 216223.CrossRefGoogle ScholarPubMed
Chiuve, SE, Rimm, EB, Sandhu, RK, et al. (2012) Dietary fat quality and risk of sudden cardiac death in women. Am J Clin Nutr 96, 498507.CrossRefGoogle ScholarPubMed
Albert, CM, Campos, H, Stampfer, MJ, et al. (2002) Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 346, 11131118.CrossRefGoogle ScholarPubMed
Lemaitre, RN, King, IB, Mozaffarian, D, et al. (2003) n-3 Polyunsaturated fatty acids, fatal ischemic heart disease, and nonfatal myocardial infarction in older adults: the Cardiovascular Health Study. Am J Clin Nutr 77, 319325.CrossRefGoogle ScholarPubMed
Kleber, ME, Delgado, GE, Lorkowski, S, et al. (2016) Omega-3 fatty acids and mortality in patients referred for coronary angiography. The Ludwigshafen Risk and Cardiovascular Health Study. Atherosclerosis 252, 175181.CrossRefGoogle ScholarPubMed
von Schacky, C (2014) Omega-3 index and cardiovascular health. Nutrients 6, 799814.CrossRefGoogle ScholarPubMed
Harris, WS, Tintle, NL, Etherton, MR, et al. (2018) Erythrocyte long-chain omega-3 fatty acid levels are inversely associated with mortality and with incident cardiovascular disease: The Framingham Heart Study. J Clin Lipidol 12, 718727.CrossRefGoogle ScholarPubMed
Hamazaki, K, Iso, H, Eshak, ES, et al. (2018) Plasma levels of n-3 fatty acids and risk of coronary heart disease among Japanese: The Japan Public Health Center-based (JPHC) study. Atherosclerosis 272, 226232.CrossRefGoogle ScholarPubMed
ASCEND Study Collaborative Group (2018) Effects of n-3 fatty acid supplements in diabetes mellitus. N Engl J Med 379, 15401550.CrossRefGoogle Scholar
Manson, JE, Cook, NR, Lee, IM, et al. (2019) Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. N Engl J Med 80, 2332.CrossRefGoogle Scholar
Manson, JE, Bassuk, SS, Cook, NR, et al. (2020) Vitamin D, marine n-3 fatty acids, and primary prevention of cardiovascular disease current evidence. Circ Res 126, 112128.CrossRefGoogle ScholarPubMed
Li, ZH, Zhong, WF, Liu, S, et al. (2020) Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study. BMJ 368, m456.Google ScholarPubMed
Burr, ML, Gilbert, JF, Holliday, RA, et al. (1989) Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet 334, 757761.CrossRefGoogle Scholar
Anonymous (1999) Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico (Italian Group for the Study of Survival in Myocardial Infarction). Lancet 354, 447455.CrossRefGoogle Scholar
Yokoyama, M, Origasa, H, Matsuzaki, M, et al. (2007) Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 369, 10901098.CrossRefGoogle ScholarPubMed
Sasaki, J, Yokoyama, M, Matsuzaki, M, et al. (2012) Relationship between coronary artery disease and non-HDL-C, and effect of highly purified EPA on the risk of coronary artery disease in hypercholesterolemic patients treated with statins: sub-analysis of the Japan EPA Lipid Intervention Study (JELIS). J Atheroscler Thromb 19, 194204.CrossRefGoogle ScholarPubMed
Rauch, B, Schiele, R, Schneider, S, et al. (2010) OMEGA, a randomized, placebo-controlled trial to test the effect of highly purified omega-3 fatty acids on top of modern guideline-adjusted therapy after myocardial infarction. Circulation 122, 21522159.CrossRefGoogle Scholar
Galan, P, Kesse-Guyot, E, Czernichow, S, et al. (2010) Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo controlled trial. BMJ 341, c6273.CrossRefGoogle ScholarPubMed
ORIGIN Trial Investigators (2012) n-3 Fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med 367, 309318.CrossRefGoogle Scholar
Risk and Prevention Study Collaborative Group (2013) n-3 Fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med 368, 18001808.Google Scholar
Bonds, DE, Harrington, M, Worrall, BB, et al. (2014) Effect of long-chain ω-3 fatty acids and lutein + zeaxanthin supplements on cardiovascular outcomes: results of the Age-Related Eye Disease Study 2 (AREDS) randomized clinical trial. JAMA Intern Med 174, 763771.Google ScholarPubMed
Bhatt, DL, Steg, PG, Miller, M, et al. (2019) Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 380, 1122.CrossRefGoogle ScholarPubMed
Bhatt, DL, Miller, M, Brinton, EA, et al. (2020) REDUCE-IT USA: results from the 3146 patients randomized in the United States. Circulation 141, 367375.Google ScholarPubMed
Nicholls, SJ, Lincoff, AM, Garcia, M, et al. (2020) Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the STRENGTH Randomized Clinical Trial. JAMA 324, 22682280.CrossRefGoogle ScholarPubMed
United States Food & Drug Administration (2019) FDA approves use of drug to reduce risk of cardiovascular events in certain adult patient groups. https://www.fda.gov/news-events/press-announcements/fda-approves-use-drug-reduce-risk-cardiovascular-events-certain-adult-patient-groups (accessed December 2020).Google Scholar
Innes, JK & Calder, PC (2020) Marine omega-3 (n-3) fatty acids for cardiovascular health: an update for 2020. Int J Mol Sci 21, 1362.CrossRefGoogle ScholarPubMed
Alexander, DD, Miller, PE, Van Elswyk, ME, et al. (2017) A meta-analysis of randomized controlled trials and prospective cohort studies of eicosapentaenoic and docosahexaenoic long-chain omega-3 fatty acids and coronary heart disease risk. Mayo Clin Proc 92, 1529.CrossRefGoogle ScholarPubMed
Maki, KC, Palacios, OM, Bell, M, et al. (2017) Use of supplemental long-chain omega-3 fatty acids and risk for cardiac death: an updated meta-analysis and review of research gaps. J Clin Lipidol 11, 11521160.CrossRefGoogle ScholarPubMed
Hu, Y, Hu, FB & Manson, JE (2019) Marine omega-3 supplementation and cardiovascular disease: an updated meta-analysis of 13 randomized controlled trials involving 127 477 participants. J Am Heart Assoc 8, e013543.CrossRefGoogle ScholarPubMed
Popoff, F, Balaciano, G, Bardach, A, et al. (2019) Omega 3 fatty acid supplementation after myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord 19, 136.CrossRefGoogle ScholarPubMed
Aung, T, Halsey, J, Kromhout, D, et al. (2018) Associations of omega-3 fatty acid supplement use with cardiovascular disease risks: meta-analysis of 10 trials involving 77 917 individuals. JAMA Cardiol 3, 225234.CrossRefGoogle ScholarPubMed
Doshi, R, Kumar, A, Thakkar, S, et al. (2020) Meta-analysis comparing combined use of eicosapentaenoic acid and statin to statin alone. Am J Cardiol 125, 198204.CrossRefGoogle ScholarPubMed
Hoang, T & Kim, J (2020) Comparative effect of statins and omega-3 supplementation on cardiovascular events: meta-analysis and network meta-analysis of 63 randomized controlled trials including 264,516 participants. Nutrients 12, E2218.CrossRefGoogle ScholarPubMed
Lombardi, M, Chiabrando, JG, Vescovo, GM, et al. (2020) Impact of different doses of omega-3 fatty acids on cardiovascular outcomes: a pairwise and network meta-analysis. Curr Atheroscler Rep 22, 45.CrossRefGoogle ScholarPubMed
Casula, M, Olmastroni, E, Gazzotti, M, et al. (2020) Omega-3 polyunsaturated fatty acids supplementation and cardiovascular outcomes: do formulation, dosage, and baseline cardiovascular risk matter? An updated meta-analysis of randomized controlled trials. Pharmacol Res 160, 105060.Google ScholarPubMed
Cabiddu, MF, Russi, A, Appolloni, L, et al. (2020) Omega-3 for the prevention of cardiovascular diseases: meta-analysis and trial-sequential analysis. Eur J Hosp Pharm 2020, ejhpharm-2020-002207.Google Scholar
Bernasconi, AA, Wiest, MM, Lavie, CJ, et al. (2020) Effect of omega-3 dosage on cardiovascular outcomes: an updated meta-analysis and meta-regression of interventional trials. Mayo Clin Proc 2020, S0025-6196(20)30985-X.Google Scholar
von Schacky, C (2020) Omega-3 index in 2018/19. Proc Nutr Soc 79, 381387.CrossRefGoogle Scholar
Siscovick, DS, Barringer, TA, Fretts, AM, et al.(2017) Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: a Science Advisory from the American Heart Association. Circulation 135, e867e884.CrossRefGoogle ScholarPubMed
Hu, FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13, 39.CrossRefGoogle ScholarPubMed
Martínez-González, MA, Gea, A & Ruiz-Canela, M (2019) The Mediterranean diet and cardiovascular health. Circ Res 124, 779798.Google ScholarPubMed
Iqbal, R, Anand, S, Ounpuu, S, et al. (2008) Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study. Circulation 118, 19291937.CrossRefGoogle ScholarPubMed
Hu, FB, Rimm, EB, Stampfer, MJ, et al. (2000) Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr 72, 912921.CrossRefGoogle ScholarPubMed
Fung, TT, Willett, WC, Stampfer, MJ, et al. (2001) Dietary patterns and the risk of coronary heart disease in women. Arch Intern Med 161, 18571862.CrossRefGoogle ScholarPubMed
Brunner, EJ, Mosdøl, A, Witte, DR, et al. (2008) Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality. Am J Clin Nutr 87, 14141421.CrossRefGoogle ScholarPubMed
United Nations Educational, Scientific and Cultural Organization (UNESCO) (2013) Intangible Cultural Heritage: Washoku, traditional dietary cultures of the Japanese, notably for the celebration of New Year. https://ich.unesco.org/en/RL/washoku-traditional-dietary-cultures-of-the-japanese-notably-for-the-celebration-of-new-year-00869 (accessed August 2020).Google Scholar
United Nations Educational, Scientific and Cultural Organization (UNESCO) (2013) Intangible Cultural Heritage: Mediterranean diet. https://ich.unesco.org/en/RL/mediterranean-diet-00884 (accessed August 2020).Google Scholar
de Lorgeril, M, Renaud, S, Mamelle, N, et al. (1994) Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 343, 14541459.CrossRefGoogle ScholarPubMed
de Lorgeril, M, Salen, P, Caillat-Vallet, E, et al. (1997) Control of bias in dietary trial to prevent coronary recurrences: The Lyon Diet Heart Study. Eur J Clin Nutr 51, 116122.CrossRefGoogle ScholarPubMed
de Lorgeril, M, Salen, P, Martin, JL, et al. (1999) Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 99, 779785.CrossRefGoogle ScholarPubMed
Kris-Etherton, P, Eckel, RH, Howard, BV, et al. (2001) Nutrition Committee Population Science Committee and Clinical Science Committee of the American Heart Association. AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association step I dietary pattern on cardiovascular disease. Circulation 103, 18231825.CrossRefGoogle ScholarPubMed
Singh, RB, Dubnov, G, Niaz, MA, et al. (2002) Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomized single-blind trial. Lancet 360, 14551461.CrossRefGoogle Scholar
Horton, R (2005) Expression of concern: Indo-Mediterranean Diet Heart Study. Lancet 366, 354356.CrossRefGoogle ScholarPubMed
Estruch, R, Ros, E, Salas-Salvadó, J, et al. (2018) Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 378, e34.CrossRefGoogle ScholarPubMed
Sofi, F, Macchi, C, Abbate, R, et al. (2014) Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 17, 27692782.CrossRefGoogle Scholar
Grosso, G, Marventano, S, Yang, J, et al. (2017) A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: are individual components equal? Crit Rev Food Sci Nutr 57, 32183232.CrossRefGoogle ScholarPubMed
Liyanage, T, Ninomiya, T, Wang, A, et al. (2016) Effects of the Mediterranean diet on cardiovascular outcomes – a systematic review and meta-analysis. PLOS ONE 11, e0159252.CrossRefGoogle ScholarPubMed
Rosato, V, Temple, NJ, La Vecchia, C, et al. (2019) Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. Eur J Nutr 58, 173191.CrossRefGoogle ScholarPubMed
Galbete, C, Schwingshackl, L, Schwedhelm, C, et al. (2018) Evaluating Mediterranean diet and risk of chronic disease in cohort studies: an umbrella review of meta-analyses. Eur J Epidemiol 33, 909931.CrossRefGoogle ScholarPubMed
Trichopoulou, A, Costacou, T, Bamia, C, et al. (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 25992608.CrossRefGoogle Scholar
Fung, TT, Rexrode, KM, Mantzoros, CS, et al. (2009) Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation 119, 10931100.CrossRefGoogle ScholarPubMed
Rees, K, Takeda, A, Martin, N, et al. (2019) Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev, issue 3, CD009825.CrossRefGoogle Scholar
O’Keefe, JH, Torres-Acosta, N, O’Keefe, EL, et al. (2020) A pesco-Mediterranean diet with intermittent fasting: JACC review topic of the week. J Am Coll Cardiol 76, 14841493.CrossRefGoogle ScholarPubMed
Keys, A, Aravanis, C, Blackburn, H, et al. (1980) Seven Countries Study. A Multivariate Analysis of Death and Coronary Artery Disease. Cambridge, MA: Harvard University Press.Google Scholar
Adachi, H, Enomoto, M, Fukami, A, et al. (2020) Trends in nutritional intake and coronary risk factors over 60 years among Japanese men in Tanushimaru. Heart Vessels 35, 901908.CrossRefGoogle ScholarPubMed
Toshima, H (1994) Coronary artery disease trends in Japan. Jpn Circ J 58, 166172.CrossRefGoogle ScholarPubMed
Tanizaki, Y, Kiyohara, Y, Kato, I, et al. (2000) Incidence and risk factors for subtypes of cerebral infarction in a general population: the Hisayama study. Stroke 31, 26162622.CrossRefGoogle Scholar
Iso, H (2011) Lifestyle and cardiovascular disease in Japan. J Atheroscler Thromb 18, 8388.CrossRefGoogle ScholarPubMed
Weir, HK, Anderson, RN, Coleman King, SM, et al. (2016) Heart Disease and Cancer Deaths – Trends and Projections in the United States, 1969–2020. https://www.cdc.gov/Pcd/issues/2016/16_0211.htm (accessed August 2020).CrossRefGoogle Scholar
Benjamin, EJ, Muntner, P, Alonso, A, et al. (2019) Heart disease and stroke statistics – 2019 update: a report from the American Heart Association. Circulation 139, e56e528.CrossRefGoogle ScholarPubMed
Finegold, JA, Asaria, P & Francis, DP (2013) Mortality from ischaemic heart disease by country region, and age: statistics from World Health Organisation and United Nations. Int J Cardiol 168, 934945.CrossRefGoogle ScholarPubMed
Yamori, Y, Miura, A & Taira, K (2001) Implications from and for food cultures for cardiovascular diseases: Japanese food, particularly Okinawan diets. Asia Pac J Clin Nutr 10, 144145.CrossRefGoogle ScholarPubMed
Yamori, Y (2006) Food factors for atherosclerosis prevention: Asian perspective derived from analyses of worldwide dietary biomarkers. Exp Clin Cardiol 11, 9498.Google ScholarPubMed
Yamori, Y, Liu, L, Mizushima, S, et al. (2006) Male cardiovascular mortality and dietary markers in 25 population samples of 16 countries. J Hypertens 24, 14991505.CrossRefGoogle ScholarPubMed
Gabriel, AS, Ninomiya, K & Uneyama, H (2018) The role of the Japanese traditional diet in healthy and sustainable dietary patterns around the world. Nutrients 10, 173.CrossRefGoogle ScholarPubMed
Dernini, S, Berry, EM, Serra-Majem, L, et al. (2017) Med Diet 4·0: the Mediterranean diet with four sustainable benefits. Public Health Nutr 20, 13221330.CrossRefGoogle ScholarPubMed