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O'Keefe, James H; Tintle, Nathan L; Harris, William S; O'Keefe, Evan L; Sala-Vila, Aleix; Attia, John; Garg, G Manohar; Hure, Alexis; Bork, Christian Sørensen; Schmidt, Erik Berg; Venø, Stine Krogh; Chien, Kuo-Liong; Chen, Yun-Yu Amelia; Egert, Sarah; Feldreich, Tobias Rudholm; Ärnlöv, Johan; Lind, Lars; Forouhi, Nita G; Geleijnse, Johanna M; Pertiwi, Kamalita; Imamura, Fumiaki; de Mello Laaksonen, Vanessa; Uusitupa, W Matti; Tuomilehto, Jaakko; Laakso, Markku; Lankinen, Maria Anneli; Laurin, Danielle; Carmichael, Pierre-Hugues; Lindsay, Joan; Leander, Karin; Laguzzi, Federica; Swenson, Brenton R; Longstreth, William T; Manson, JoAnn E; Mora, Samia; Cook, Nancy R; Marklund, Matti; Melo van Lent, Debora; Murphy, Rachel; Gudnason, Vilmundur; Ninomiya, Toshihara; Hirakawa, Yoichiro; Qian, Frank; Sun, Qi; Hu, Frank; Ardisson Korat, Andres V; Risérus, Ulf; Lázaro, Iolanda; Samieri, Cecilia; Le Goff, Mélanie; Helmer, Catherine; Steur, Marinka; Voortman, Trudy; Ikram, M Kamran; Tanaka, Toshiko; Das, Jayanta K; Ferrucci, Luigi; Bandinelli, Stefania; Tsai, Michael; Guan, Weihua; Garg, Parveen; Verschuren, W M Monique; Boer, Jolanda M A; Biokstra, Anneke; Virtanen, Jyrki; Wagner, Michael; Westra, Jason; Albuisson, Luc; Yamagishi, Kazumasa; Siscovick, David S; Lemaitre, Rozenn N; Mozaffarian, Dariush
Stroke (1970), 01/2024, Volume: 55, Issue: 1Journal Article
The effect of marine omega-3 PUFAs on risk of stroke remains unclear. We investigated the associations between circulating and tissue omega-3 PUFA levels and incident stroke (total, ischemic, and hemorrhagic) in 29 international prospective cohorts. Each site conducted a de novo individual-level analysis using a prespecified analytical protocol with defined exposures, covariates, analytical methods, and outcomes; the harmonized data from the studies were then centrally pooled. Multivariable-adjusted HRs and 95% CIs across omega-3 PUFA quintiles were computed for each stroke outcome. Among 183 291 study participants, there were 10 561 total strokes, 8220 ischemic strokes, and 1142 hemorrhagic strokes recorded over a median of 14.3 years follow-up. For eicosapentaenoic acid, comparing quintile 5 (Q5, highest) with quintile 1 (Q1, lowest), total stroke incidence was 17% lower (HR, 0.83 CI, 0.76-0.91; <0.0001), and ischemic stroke was 18% lower (HR, 0.82 CI, 0.74-0.91; <0.0001). For docosahexaenoic acid, comparing Q5 with Q1, there was a 12% lower incidence of total stroke (HR, 0.88 CI, 0.81-0.96; =0.0001) and a 14% lower incidence of ischemic stroke (HR, 0.86 CI, 0.78-0.95; =0.0001). Neither eicosapentaenoic acid nor docosahexaenoic acid was associated with a risk for hemorrhagic stroke. These associations were not modified by either baseline history of AF or prevalent CVD. Higher omega-3 PUFA levels are associated with lower risks of total and ischemic stroke but have no association with hemorrhagic stroke.
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