Novel Classification of Cardiovascular Disease Subtypes Reveals Associations Between Mortality and Polyunsaturated Fatty Acids: Insights from the United Kingdom Biobank Study

IF 3.8 Q2 NUTRITION & DIETETICS Current Developments in Nutrition Pub Date : 2024-09-01 DOI:10.1016/j.cdnut.2024.104434
Jiamei Li , Haiqing Zheng , Xuanhui Chen , Shuo Ma , Qing Li , Jiaqi Sun , Ziying Chen , Yunyi Li , Dantong Li , Miao Lin , Huiying Liang , Huixian Li
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Abstract

Background

Traditional association studies of cardiovascular disease (CVD) categorizations and polyunsaturated fatty acids (PUFAs) yielded conflicting findings. We propose a novel classification system based on fundamental characteristics of cardiovascular patients, such as age, body mass index, waist–hip ratio, to more accurately assess the impact of PUFAs (plasma measures) such as omega (ω)-3 (n–3) and ω-6 on mortality in cardiovascular patients.

Methods

Principal component analysis and k-means clustering were used to determine the CVD subtype. Variables included age, body mass index, waist–hip ratio, diastolic blood pressure, systolic blood pressure, total cholesterol, total triglycerides, high-density lipoprotein-cholesterol, apolipoprotein B:apolipoprotein A1, glycated hemoglobin, creatinine, albumin, C-reactive protein, white blood cell count, platelet count, and hemoglobin concentration. The association of PUFAs with all-cause, cardiovascular, and ischemic heart disease (IHD) mortality in patients with CVD was prospectively evaluated using restricted cubic splines and Cox proportional risk models.

Results

Among the 35,096 participants, 3,786 fatalities occurred. Three distinct CVD subtypes were identified, with cluster 3 characterized by older age, male gender, and low high-density lipoprotein-cholesterol, having the highest risk of mortality. Clusters 2 and 3 had the highest DHA and ω-6/ω-3 ratios, respectively, compared with Cluster 1. The protective effects of total PUFAs, ω-3, and DHA were mainly reflected in all-cause mortality and were more significant in clusters 2 and 3. Furthermore, the ω-6/ω-3 ratio of the highest quartile increased risk of all-cause [Q3: hazard ratio (HR): 1.14, 95% confidence interval [CI]: 1.00, 1.29; Q4: HR: 1.41, 95% CI: 1.24, 1.61], CVD (Q4: HR: 1.36, 95% CI: 1.07, 1.75), and IHD mortality (Q4: HR: 1.17, 95% CI: 1.12, 2.03) in cluster 3 compared with the first quartile.

Conclusions

Our findings highlight the heterogeneity of associations observed for the same type of PUFAs across distinct clusters. This association may be elucidated by the intricate interplay of various factors, encompassing inflammation, lipid metabolism, and cardiovascular health.

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心血管疾病亚型的新分类揭示了死亡率与多不饱和脂肪酸之间的关系:英国生物库研究的启示
背景传统的心血管疾病(CVD)分类与多不饱和脂肪酸(PUFAs)的关联研究得出了相互矛盾的结论。我们根据心血管疾病患者的基本特征,如年龄、体重指数、腰臀比等,提出了一种新的分类系统,以更准确地评估ω (ω)-3 (n-3)和ω-6等多不饱和脂肪酸(血浆测量值)对心血管疾病患者死亡率的影响。变量包括年龄、体重指数、腰臀比、舒张压、收缩压、总胆固醇、总甘油三酯、高密度脂蛋白胆固醇、载脂蛋白B:载脂蛋白A1、糖化血红蛋白、肌酐、白蛋白、C反应蛋白、白细胞计数、血小板计数和血红蛋白浓度。采用限制性三次样条和 Cox 比例风险模型对 PUFA 与心血管疾病患者的全因、心血管和缺血性心脏病 (IHD) 死亡率的关系进行了前瞻性评估。发现了三种不同的心血管疾病亚型,其中以年龄较大、男性和低高密度脂蛋白胆固醇为特征的第 3 组的死亡风险最高。与群组1相比,群组2和群组3的DHA和ω-6/ω-3比率分别最高。总 PUFA、ω-3 和 DHA 的保护作用主要体现在全因死亡率上,并且在群组 2 和 3 中更为显著。此外,最高四分位数的ω-6/ω-3比率增加了全因死亡风险[Q3:危险比(HR):1.14,95%置信区间[CI]:1.00,1.29;Q4:危险比(HR):1.00,1.29;Q5:危险比(HR):1.00,1.29]:与第一四分位数相比,第三组的心血管疾病(第四季度:心血管疾病死亡率:1.36,95% 置信区间[CI]:1.07,1.75)、心肌梗死(第四季度:心血管疾病死亡率:1.17,95% 置信区间[CI]:1.12,2.03)死亡率增加。炎症、脂质代谢和心血管健康等各种因素之间错综复杂的相互作用可能会阐明这种关联。
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来源期刊
Current Developments in Nutrition
Current Developments in Nutrition NUTRITION & DIETETICS-
CiteScore
5.30
自引率
4.20%
发文量
1327
审稿时长
8 weeks
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