Individual omega-9 monounsaturated fatty acids and mortality—The Ludwigshafen Risk and Cardiovascular Health Study Graciela E. Delgado, MSc, Bernhard.

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Date of download: 6/17/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Major Lipids, Apolipoproteins, and Risk of Vascular.

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Individual omega-9 monounsaturated fatty acids and mortality—The Ludwigshafen Risk and Cardiovascular Health Study Graciela E. Delgado, MSc, Bernhard K. Krämer, MD, Stefan Lorkowski, PhD, Winfried März, MD, Clemens von Schacky, MD, Marcus E. Kleber, PhD Journal of Clinical Lipidology Volume 11, Issue 1, Pages 126-135.e5 (January 2017) DOI: 10.1016/j.jacl.2016.10.015 Copyright © 2016 National Lipid Association Terms and Conditions

Figure 1 Metabolism of omega-9 fatty acids in humans. The three omega-9 fatty acids analyzed in this study are red-rimmed. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions

Figure 2 Association of omega-9 FA with mortality. Risk of all-cause mortality per 1-SD increase in OA, GA, and NA in the whole cohort (A), men (B), and women (C). Model 1: adjusted for age and gender; model 2: additionally adjusted for BMI, LDL-C, HDL-C, logTG, hypertension, diabetes mellitus, smoking, and lipid-lowering therapy; model 3: additionally adjusted for eGFR. BMI, body mass index; GA, gondoic acid; HDL-C, HDL cholesterol; LDL-C, LDL cholesterol; NA, nervonic acid; OA, oleic acid; TG, triglycerides. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions

Figure 3 Relationship between omega-9 MUFA and all-cause mortality. OA (A), GA (B), and NA (C) were modeled as restricted cubic spline in Cox regression analysis adjusted for age, gender, BMI, LDL-C, HDL-C, logTG, hypertension, diabetes mellitus, smoking and lipid-lowering therapy. Their concentration was plotted against the respective log relative hazard with 95% confidence intervals. GA, gondoic acid; NA, nervonic acid; OA, oleic acid. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions

Figure 4 Correlation analysis of omega-9 MUFA with LA, ARA, EPA, DHA and SFA. A darker coloration indicates a stronger correlation. Correlations not significant at α < 0.01 have white background. ARA, arachidonic acid; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; LA, linoleic acid; SFA, total saturated fatty acids. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions

Figure 5 Adjusted survival curves for cardiovascular mortality. Quartiles of nervonic acid were balanced for age, gender, eGFR, smoking, diabetes mellitus, EPA, ARA, and LA by inverse variance weighting. The inset shows the same data on a truncated y-axis. The P value of the robust score test was 5.78e−14. ARA, arachidonic acid; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; LA, linoleic acid. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions

Supplementary Figure 1 Distribution of omega-9 MUFA in LURIC. Box plots showing the distribution of OA (A), GA (B), and NA (C) in LURIC stratified by gender. The boxes represent the interquartile ranges (IQR), median values are shown as black lines. Whiskers extend to the data point closest to a distance 1.5 times the IQR away from the median. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions

Supplementary Figure 2 Association of omega-9 MUFA with cardiovascular mortality. Risk of cardiovascular mortality per 1-SD increase of OA, GA, and NA in men (A), women (B), and combined (C). Model 1: adjusted for age and gender; model 2: additionally adjusted for BMI, LDL-C, HDL-C, logTG, hypertension, diabetes, smoking, and lipid-lowering therapy; model 3: additionally adjusted for eGFR. BMI, body mass index; GA, gondoic acid; HDL-C, HDL cholesterol; LA, Linoleic acid; LDL-C, LDL cholesterol; NA, nervonic acid; OA, oleic acid; TG, triglycerides. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions

Supplementary Figure 3 Association of omega-9 MUFA with cardiovascular mortality in participants with coronary artery disease at baseline. Risk of cardiovascular mortality per 1-SD increase in OA, GA and NA. Model 1: adjusted for age and gender; model 2: additionally adjusted for BMI, LDL-C, HDL-C, logTG, hypertension, diabetes, smoking and lipid-lowering therapy; model 3: additionally adjusted for eGFR. BMI, body mass index; GA, gondoic acid; HDL-C, HDL cholesterol; LA, linoleic acid; LDL-C, LDL cholesterol; NA, nervonic acid; OA, oleic acid; TG, triglycerides. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions

Supplementary Figure 4 Association of omega-9 MUFA with cardiovascular mortality in participants with chronic kidney disease at baseline. Risk of cardiovascular mortality per 1-SD increase in OA, GA, and NA. Model 1, adjusted for age and gender; model 2, additionally adjusted for BMI, LDL-C, HDL-C, logTG, hypertension, diabetes, smoking, and lipid-lowering therapy; model 3, additionally adjusted for eGFR. BMI, body mass index; GA, gondoic acid; HDL-C, HDL cholesterol; LA, linoleic acid; LDL-C, LDL cholesterol; NA, nervonic acid; OA, oleic acid; TG, triglycerides. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions

Supplementary Figure 5 Association of omega-9 MUFA with cardiovascular mortality in study participants without CAD and without CKD at baseline. Risk of cardiovascular mortality per 1-SD increase in OA, GA, and NA. Model 1: adjusted for age and gender; model 2: additionally adjusted for BMI, LDL-C, HDL-C, logTG, hypertension, diabetes, smoking, and lipid-lowering therapy; model 3: additionally adjusted for eGFR. BMI, body mass index; GA, gondoic acid; HDL-C, HDL cholesterol; LA, linoleic acid; LDL-C, LDL cholesterol; NA, nervonic acid; OA, oleic acid; TG, triglycerides. Journal of Clinical Lipidology 2017 11, 126-135.e5DOI: (10.1016/j.jacl.2016.10.015) Copyright © 2016 National Lipid Association Terms and Conditions