The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Circulating Long-Chain ω-3 Fatty Acids and Incidence of Congestive Heart Failure in Older Adults: The Cardiovascular Health Study: A Cohort Study

Dariush Mozaffarian, MD, DrPH; Rozenn N. Lemaitre, PhD, MPH; Irena B. King, PhD; Xiaoling Song, PhD; Donna Spiegelman, ScD; Frank M. Sacks, MD; Eric B. Rimm, ScD; and David S. Siscovick, MD, MPH
[+] Article, Author, and Disclosure Information

From Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; University of New Mexico, Albuquerque, New Mexico; and Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington.

Acknowledgment: The authors thank the CHS participants. A full list of CHS investigators and institutions is available at www.chs-nhlbi.org.

Grant Support: By grant R01-HL-085710-01 from the National Heart, Lung, and Blood Institute, with cofunding from the Office of Dietary Supplements. The National Heart, Lung, and Blood Institute provided further support for the CHS (contracts N01-HC-35129, N01-HC-45133, N01-HC-75150, N01-HC-85079 through N01-HC-85086, N01-HC-15103, N01-HC-55222, and U01-HL080295), with additional contributions from the National Institute of Neurological Disorders and Stroke.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0308.

Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Mozaffarian (e-mail, dmozaffa@hsph.harvard.edu). Data set: Available through established CHS procedures for obtaining and analyzing data; see www.chs-nhlbi.org/CHS_DistribPolicy.htm.

Requests for Single Reprints: Dariush Mozaffarian, MD, DrPH, Harvard School of Public Health, 665 Huntington Avenue, Building 2-319, Boston, MA 02115; e-mail, dmozaffa@hsph.harvard.edu.

Current Author Addresses: Dr. Mozaffarian: Harvard School of Public Health, 665 Huntington Avenue, Building 2-319, Boston, MA 02115.

Drs. Lemaitre and Siscovick: Cardiovascular Health Research Unit, University of Washington, 1730 Minor Avenue, Suite 1360, Seattle, WA 98101.

Dr. King: University of New Mexico, 2703 Frontier Avenue Northeast, Suite 190, Albuquerque, NM 87131.

Dr. Song: Fred Hutchinson Cancer Research Center, M5 A864, 1100 Fairview Avenue North, Seattle, WA 98109.

Drs. Spiegelman, Sacks, and Rimm: Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115.

Author Contributions: Conception and design: D. Mozaffarian, D.S. Siscovick.

Analysis and interpretation of the data: D. Mozaffarian, R.N. Lemaitre, I.B. King, X. Song, D. Spiegelman, F.M. Sacks, D.S. Siscovick.

Drafting of the article: D. Mozaffarian.

Critical revision of the article for important intellectual content: D. Mozaffarian, R.N. Lemaitre, X. Song, F.M. Sacks, E.B. Rimm, D.S. Siscovick.

Final approval of the article: D. Mozaffarian, R.N. Lemaitre, I.B. King, X. Song, F.M. Sacks, D.S. Siscovick.

Provision of study materials or patients: D. Mozaffarian.

Statistical expertise: D. Mozaffarian, D. Spiegelman.

Obtaining of funding: D. Mozaffarian, I.B. King, D.S. Siscovick.

Administrative, technical, or logistic support: D. Mozaffarian, X. Song.

Collection and assembly of data: D. Mozaffarian, I.B. King, X. Song, D.S. Siscovick.

Ann Intern Med. 2011;155(3):160-170. doi:10.7326/0003-4819-155-3-201108020-00006
Text Size: A A A

Background: Few previous studies have evaluated associations between long-chain ω-3 fatty acids and incidence of congestive heart failure (CHF), and those that have are typically based on diet questionnaires and yield conflicting results. Circulating fatty acid concentrations provide objective biomarkers of exposure.

Objective: To determine whether plasma phospholipid concentrations of long-chain ω-3 fatty acids, including eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA), were associated with incident CHF.

Design: Prospective cohort study.

Setting: 4 U.S. communities.

Patients: 2735 U.S. adults without prevalent heart disease who were enrolled in the Cardiovascular Health Study from 1992 to 2006.

Measurements: Plasma phospholipid fatty acid concentrations and other cardiovascular risk factors were measured in 1992 by using standardized methods. Relationships with incident CHF (555 cases during 26 490 person-years, adjudicated by using medical records) were assessed by using Cox proportional hazards models.

Results: After multivariate adjustment, plasma phospholipid EPA concentration was inversely associated with incident CHF; risk was approximately 50% lower in the highest versus the lowest quartile (hazard ratio [HR], 0.52 [95% CI, 0.38 to 0.72]; P for trend = 0.001). In similar analyses, trends toward lower risk were seen for DPA (HR, 0.76 [CI, 0.56 to 1.04]; P for trend = 0.057) and total long-chain ω-3 fatty acids (HR, 0.70 [CI, 0.49 to 0.99]; P for trend = 0.062) but not for DHA (HR, 0.84 [CI, 0.58 to 1.21]; P for trend = 0.38). In analyses censored to the middle of follow-up (7 years) to minimize exposure misclassification over time, multivariate-adjusted HRs were 0.48 for EPA (CI, 0.32 to 0.71; P for trend = 0.005), 0.61 for DPA (CI, 0.39 to 0.95; P for trend = 0.033), 0.64 for DHA (CI, 0.40 to 1.04; P for trend = 0.057), and 0.51 for total ω-3 fatty acids (CI, 0.32 to 0.80; P for trend = 0.003).

Limitations: Temporal changes in fatty acid concentrations over time may have caused underestimation of associations. Unmeasured or imperfectly measured covariates may have caused residual confounding.

Conclusion: Circulating individual and total ω-3 fatty acid concentrations are associated with lower incidence of CHF in older adults.

Primary Funding Source: National Institutes of Health.


Grahic Jump Location
Nonparametric multivariate-adjusted relationship between plasma phospholipid EPA concentrations and incidence of CHF.

This relationship was evaluated by using restricted cubic splines and with covariates and regression dilution correction as described in the footnote for Table 3. The solid line and shaded area represent the central risk estimate and 95% CIs, respectively. Higher concentrations of EPA were associated with lower incidence of CHF (P = 0.001), with no statistical evidence for a nonlinear dose-response (P for nonlinearity = 0.33). CHF = congestive heart failure; EPA = eicosapentaenoic acid.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Omega 3 f. acids and heart failure.The Cardiovascular Health Study
Posted on August 24, 2011
Sabino Guillermo Echebarria Mendieta
Conflict of Interest: None Declared

The classical studies have described the relation between high intake of saturated fat anf the risk for heart disease , whereas dietas rich in monounsaturated and polyunsaturated fat are protective .The study in the BMJ 1996 ( 313: 84 ) showed only a weak association between dietary fat intake and coronary heart disease , as well as a reduced risk for ischemic stroke due to consumption of omega-3 polyunsaturated fats in fish ( JAMA 2002 ; 288 : 313 ) .

The well-known benefits of omega-3 acids ( eicosapenthaenoic ( EPA ) and docosahexaenoic ( DHA ) ) and their use in severe hypertryglyceridaemia ( HTG ) , has associated benefits in endothelial dysfunction . Their role in pleitropic effects associated to heart failure are hypothetical mechanisms.

Conflict of Interest:

None declared

Submit a Comment/Letter

Summary for Patients

Omega-3 Fatty Acids and Congestive Heart Failure in Older Adults

The full report is titled “Circulating Long-Chain ω-3 Fatty Acids and Incidence of Congestive Heart Failure in Older Adults: The Cardiovascular Health Study. A Cohort Study.” It is in the 2 August 2011 issue of Annals of Internal Medicine (volume 155, pages 160-170). The authors are D. Mozaffarian, R.N. Lemaitre, I.B. King, X. Song, D. Spiegelman, F.M. Sacks, E.B. Rimm, and D.S. Siscovick.


Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.