Key Findings
Ischemic heart disease (IHD) can be assessed by measurement of carotid intima media thickness (IMT). ALA and DHA showed inverse associations with carotid IMT in 451 Spanish subjects with primary dyslipidemia who were phenotyped for cardiovascular risk factors. Nuts are a primary source of ALA in the Mediterranean diet, and may in part explain the Spanish paradox of low IHD rates in the context of a high fat diet.
ABSTRACT
Low rates of incident ischemic heart disease (IHD) and cardiac death occur in Spain despite a high prevalence of cardiovascular risk factors. High consumption of unsaturated fatty acid rich foods, such as olive oil, nuts, and seafood, might underlie this paradox. We investigated whether serum phosphatidylcholine enrichment in oleic, linoleic, alpha linolenic, and n3 (omega3) long chain polyunsaturated fatty acids (as biomarkers of olive oil, seed oil, walnut, and fish intake, respectively) relate to carotid atherosclerosis in Spanish subjects at risk of IHD. In a cross sectional study, we measured fatty acid concentrations in serum phosphatidylcholine and measured carotid intima media thickness (IMT) by using ultrasound in 451 asymptomatic subjects (261 men, 190 women; mean age 45 y) with primary dyslipidemia. Main and secondary outcomes were mean and maximum IMT in the common carotid artery (CCA) and other carotid segments, respectively. Phosphatidylcholine fatty acid composition was similar to that reported for other Spanish populations. Multiple regression analyses showed that proportions of oleic and docosahexaenoic acids were inversely related to mean CCA IMT (P less than 0.02, all) after adjustment for several confounders. In similar models, alpha linolenic acid related inversely to mean and maximum internal carotid artery IMT (P less than 0.05 for all). Linoleic and eicosapentaenoic acids were unrelated to IMT. Higher phospholipid proportions of oleic, alpha linolenic, and docosahexaenoic acids showed inverse associations with IMT at specific carotid segments in subjects with primary dyslipidemia. High intakes of healthy fats might explain, in part, the Spanish paradox of low IHD rates in the face of a high burden of cardiovascular risk factors. (Authors abstract)
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