Omega-3 Blood Levels and Stroke Risk: A Pooled and Harmonized Analysis of 183 291 Participants From 29 Prospective Studies.
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O'Keefe James H, Tintle Nathan L, Harris William S, O'Keefe Evan L, Sala-Vila Aleix, Attia John, Garg G Manohar, Hure Alexis, Bork Christian Sørensen, Schmidt Erik Berg, Venø Stine Krogh, Chien Kuo-Liong, Chen Yun-Yu Amelia, Egert Sarah, Feldreich Tobias Rudholm, Ärnlöv Johan, Lind Lars, Forouhi Nita G, Geleijnse Johanna M, Pertiwi Kamalita, Imamura Fumiaki, de Mello Laaksonen Vanessa, Uusitupa W Matti, Tuomilehto Jaakko, Laakso Markku, Lankinen Maria Anneli, Laurin Danielle, Carmichael Pierre-Hugues, Lindsay Joan, Leander Karin, Laguzzi Federica, Swenson Brenton R, Longstreth William T, Manson JoAnn E, Mora Samia, Cook Nancy R, Marklund Matti, Melo van Lent Debora, Murphy Rachel, Gudnason Vilmundur, Ninomiya Toshihara, Hirakawa Yoichiro, Qian Frank, Sun Qi, Hu Frank, Ardisson Korat Andres V, Risérus Ulf, Lázaro Iolanda, Samieri Cecilia, Le Goff Mélanie, Helmer Catherine, Steur Marinka, Voortman Trudy, Ikram M Kamran, Tanaka Toshiko, Das Jayanta K, Ferrucci Luigi, Bandinelli Stefania, Tsai Michael, Guan Weihua, Garg Parveen, Verschuren W M Monique, Boer Jolanda M A, Biokstra Anneke, Virtanen Jyrki, Wagner Michael, Westra Jason, Albuisson Luc, Yamagishi Kazumasa, Siscovick David S, Lemaitre Rozenn N, Mozaffarian Dariush
Аннотация
METHODS: We investigated the associations between circulating and tissue omega-3 PUFA levels and incident stroke (total, ischemic, and hemorrhagic) in 29 international prospective cohorts. Each site conducted a de novo individual-level analysis using a prespecified analytical protocol with defined exposures, covariates, analytical methods, and outcomes; the harmonized data from the studies were then centrally pooled. Multivariable-adjusted HRs and 95% CIs across omega-3 PUFA quintiles were computed for each stroke outcome.
RESULTS: Among 183 291 study participants, there were 10 561 total strokes, 8220 ischemic strokes, and 1142 hemorrhagic strokes recorded over a median of 14.3 years follow-up. For eicosapentaenoic acid, comparing quintile 5 (Q5, highest) with quintile 1 (Q1, lowest), total stroke incidence was 17% lower (HR, 0.83 [CI, 0.76-0.91]; P<0.0001), and ischemic stroke was 18% lower (HR, 0.82 [CI, 0.74-0.91]; P<0.0001). For docosahexaenoic acid, comparing Q5 with Q1, there was a 12% lower incidence of total stroke (HR, 0.88 [CI, 0.81-0.96]; P=0.0001) and a 14% lower incidence of ischemic stroke (HR, 0.86 [CI, 0.78-0.95]; P=0.0001). Neither eicosapentaenoic acid nor docosahexaenoic acid was associated with a risk for hemorrhagic stroke. These associations were not modified by either baseline history of AF or prevalent CVD.
CONCLUSIONS: Higher omega-3 PUFA levels are associated with lower risks of total and ischemic stroke but have no association with hemorrhagic stroke.