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The opposite associations of long-chain versus very long-chain monounsaturated fatty acids with mortality among patients with coronary artery disease
  1. Zhongxia Li1,
  2. Yuan Zhang2,
  3. Dongfang Su3,
  4. Xiaofei Lv1,
  5. Min Wang1,
  6. Ding Ding1,4,5,
  7. Jing Ma1,4,
  8. Min Xia1,4,
  9. Dongliang Wang1,4,
  10. Yan Yang1,4,
  11. Jian Qiu2,
  12. Gang Hu5,
  13. Wenhua Ling1,4
  1. 1Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
  2. 2Department of Cardiology General Hospital of Guangzhou Military Command of People's Liberation Army, Guangdong, China
  3. 3State Key Laboratory of Oncology in South China and Department of Clinical Nutrition Support Center, Sun Yat-sen University Cancer Center, Guangzhou, China
  4. 4Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong, China
  5. 5Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
  1. Correspondence to Dr Wenhua Ling, Number 74 Zhongshan Road 2, Guangzhou, Guangdong 510080, P.R. China; lingwh{at} or Dr. Gang Hu, Number 6400 Perkins Road, Baton Rouge, LA 70808, US;{at}


Objective Epidemiological evidence suggests that different lengths of carbon chains might predict cardiovascular disease (CVD) events differently. However, little data exist concerning the effects of specific types of monounsaturated fatty acids (MUFAs) stratified by chain length. Therefore, the study aimed to explore whether the associations of long-chain MUFAs (LC-MUFAs: 16:1n-7 and 18:1n-9) and very long-chain MUFAs (VLC-MUFAs: 20:1n-9, 22:1n-9 and 24:1n-9) with mortality were different among patients with coronary artery disease (CAD).

Methods Erythrocyte membrane fatty acids were measured at baseline in 1320 Chinese patients with CAD (56.2% were newly diagnosed) in the Guangdong Coronary Artery Cohort from 2008 to 2011. Cox proportional hazards models were used to estimate the association of each MUFA with risk of all-cause mortality and CVD mortality.

Results During 4229 person-years of follow-up, 104 deaths occurred, 80 of which were due to CVD. There were no statistically significant associations between overall MUFAs and all-cause mortality and CVD mortality. When we stratified MUFAs, comparing with the lowest quartile, multivariable-adjusted HRs in the top quartile of LC-MUFAs were 0.40 (95% CI 0.21 to 0.75) for all-cause mortality and 0.41 (95% CI 0.20 to 0.85) for CVD mortality, whereas multivariable-adjusted HRs in the highest quartile of VLC-MUFAs were 2.72 (95% CI 1.47 to 5.01) for all-cause mortality and 2.58 (95% CI 1.30 to 5.10) for CVD mortality.

Conclusions This study showed an inverse association between LC-MUFAs and mortality and a positive association between VLC-MUFAs and mortality among patients with CAD. These findings may help explain some of the reported controversial effects of MUFAs.


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