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David E. Laaksonen, MD, PhD, MPH; Kristiina Nyyssönen, PhD; Leo Niskanen, MD, PhD; Tiina H. Rissanen, PhD; Jukka T. Salonen, MD, PhD, MScPH

Arch Intern Med. 2005;165:193-199.

Background  Substitution of dietary polyunsaturated for saturated fat has long been recommended for the primary prevention of cardiovascular disease (CVD), but only a few prospective cohort studies have provided support for this advice.

Methods  We assessed the association of dietary linoleic and total polyunsaturated fatty acid (PUFA) intake with cardiovascular and overall mortality in a population-based cohort of 1551 middle-aged men. Dietary fat composition was estimated with a 4-day food record and serum fatty acid composition.

Results  During the 15-year follow-up, 78 men died of CVD and 225 of any cause. Total fat intake was not related to CVD or overall mortality. Men with an energy-adjusted dietary intake of linoleic acid (relative risk [RR] 0.39; 95% confidence interval [CI], 0.21-0.71) and PUFA (RR, 0.38; 95% CI, 0.20-0.70) in the upper third were less likely to die of CVD than men with intake in the lower third after adjustment for age. Multivariate adjustment weakened the association somewhat. Mortality from CVD was also lower for men with proportions of serum esterified linoleic acid (RR, 0.42; 95% CI, 0.21-0.80) and PUFA (RR, 0.25; 95% CI, 0.12-0.50) in the upper vs lower third, with some attenuation in multivariate analyses. Serum and to a lesser extent dietary linoleic acid and PUFA were also inversely associated with overall mortality.

Conclusions  Dietary polyunsaturated and more specifically linoleic fatty acid intake may have a substantial cardioprotective benefit that is also reflected in overall mortality. Dietary fat quality seems more important than fat quantity in the reduction of cardiovascular mortality in men.

Author Affiliations: Department of Physiology (Dr Laaksonen), Research Institute of Public Health (Drs Nyyssönen, Rissanen, and Salonen), and Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland (Drs Rissanen and Salonen); Department of Medicine, Kuopio University Hospital, Kuopio (Drs Laaksonen and Niskanen); Inner Savo Health Center, Suonenjoki, Finland (Dr Salonen); and Jurilab Ltd, Kuopio (Dr Salonen).

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