N-6 and n-3 fatty acid cholesteryl esters in relation to incident stroke in a Dutch adult population: A nested case-control study

Background and aims - There are few prospective studies on fatty acid status in relation to incident stroke, with inconsistent results. We assessed the associations of plasma n-6 and n-3 PUFA in cholesteryl esters with the risk of total stroke and stroke subtypes in Dutch adults. Methods and results - We conducted a nested case–control study using data from a population-based cohort study in adults aged 20–65 years. Blood sampling and data collection took place during 1993–1997 and subjects were followed for 8–13 years. We identified 179 incident cases of stroke and 179 randomly selected controls, matched on age, gender, and enrollment date. Odds ratios (OR) with 95% confidence intervals (95%CI) were calculated per standard deviation (SD) increase of PUFA in cholesteryl esters using multivariable conditional logistic regression. Cases comprised 93 ischemic, 50 hemorrhagic, and 36 unspecified strokes. The n-6 PUFA linoleic acid and arachidonic acid contributed ~55% and ~6.5% respectively to total plasma fatty acids, whereas the n-3 PUFA alpha-linolenic acid contributed ~0.5% and eicosapentaenoic acid plus docosahexaenoic acid (EPA-DHA) ~1.3%. After adjustment for confounders, n-6 and n-3 PUFA were not associated with incident total stroke or stroke subtypes. The OR (95% CI) for total stroke was 0.95 (0.74–1.23) per SD increase in linoleic acid and 1.02 (0.80–1.30) per SD increase in arachidonic acid. ORs (95% CI) for total stroke were 0.94 (0.72–1.21) for alpha-linolenic acid and 1.16 (0.94–1.45) for EPA-DHA. Conclusion - In the present study, plasma n-6 or n-3 fatty acids were not related to incident stroke or stroke subtypes.