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00925njm 22002777a 4500 dc Sala Vila, Aleix author Guasch-Ferré, Marta author Hu, Frank B. author Sánchez Tainta, Ana author Bulló, Mònica author Serra-Mir, Mercè author López Sabater, María del Carmen author Sorlí, José V. author Arós, Fernando author Fiol Sala, Miguel author Muñoz Pérez, Miguel Ángel author Serra Majem, Lluís author Martínez, J. Alfredo, 1957- author Corella Piquer, Dolores author Fitó Colomer, Montserrat author Salas Salvadó, Jordi author Martínez-González, Miguel Ángel, 1957- author Estruch Riba, Ramon author Ros Rahola, Emilio author Vinyoles, Ernest author PREDIMED Study Investigators author 2017-01-31T13:38:24Z 2017-01-31T13:38:24Z 2015-01-26 2017-01-31T13:38:24Z Background Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56-0.92) for all‐cause mortality and 0.95 (95% CI 0.58-1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67-1.05) for all‐cause mortality, 0.61 (95% CI 0.39-0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29-0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22-1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45-0.87]). Conclusions In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Àcids grassos en la nutrició Factors de risc en les malalties Hàbits alimentaris Dieta Sistema cardiovascular Cuina mediterrània Fatty acids in human nutrition Risk factors in diseases Food habits Diet Cardiovascular system Mediterranean cooking Dietary α-Linolenic Acid, Marine ω-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study