From Medscape Education Clinical Briefs

Omega-3 Long-Chain PUFA Intake May Be Cardioprotective in Women CME

News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD

CME Released: 09/19/2011; Valid for credit through 09/19/2012

 

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CME Information

Target Audience

This article is intended for primary care clinicians, cardiologists, and other specialists who provide care to persons at risk for ischemic heart disease.

Goal

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Authors and Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Laurie Barclay, MD
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Brande Nicole Martin
CME Clinical Editor, Medscape, LLC
Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.

Penny Murata, MD
Clinical Professor, Pediatrics, University of California, Irvine, California
Pediatric Clerkship Director, University of California, Irvine, California
Disclosure: Penny Murata, MD, has disclosed no relevant financial relationships.

Sarah Fleischman
CME Program Manager, Medscape, LLC
Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

Learning Objectives

Upon completion of this activity, participants will be able to:

  1. Report the association between α-linolenic acid intake and the risk for ischemic heart disease and any modifying effect by omega-3 long-chain polyunsaturated fatty acid or linolenic acid intake.
  2. Report whether omega-3 long-chain polyunsaturated fatty acid or linolenic acid intake affects the risk for ischemic heart disease.

Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)

All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Accreditation Statements

For Physicians

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only credit commensurate with the extent of their participation in the activity.

This activity, Medscape Education Clinical Briefs has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2011. Term of approval is for 1 year from this date. Each issue is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of this issue.

Note: Total credit is subject to change based on topic selection and article length.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

AAFP Accreditation Questions

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net

CME Released: 09/19/2011; Valid for credit through 09/19/2012

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

Hardware/Software Requirements

To access Medscape Education users will need

  • A computer with an Internet connection.
  • Internet Explorer 6.x or higher, Firefox 2.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser.
  • Adobe Flash Player and/or an HTML5 capable browser may be required for video or audio playback.
  • Occasionally other additional software may be required such as PowerPoint or Adobe Acrobat Reader.
 

Clinical Context

High intake of omega-3 (n-3) long-chain polyunsaturated fatty acids (LC-PUFA) from fish or fish oil is beneficial in ischemic heart disease (IHD), according to Mozaffarian and Rimm in the October 18, 2006, issue of the Journal of the American Medical Association. However, in some countries, the main source of n-3 fatty acids is α-linolenic acid (ALA) from plant oils and nuts. Also, the intake of linolenic acid (LA), an n-6 PUFA, influences the conversion of ALA.

This prospective cohort study uses data from the Glostrup Population Studies, described by Schroll and colleagues in the June 1992 issue of the Danish Medical Bulletin, to access the association between ALA intake and IHD risk and whether any association is modified by intake of n-3 LC-PUFA or LA.

Study Synopsis and Perspective

High intake of n-3 LC-PUFA may be cardioprotective in women, according to the results of a prospective cohort study reported online August 24 in the American Journal of Clinical Nutrition.

"n-3...PUFA has been proposed as having health-promoting effects, primarily in relation to ...IHD," write Mia Sadowa Vedtofte, from the Research Unit for Dietary Studies at the Institute of Preventive Medicine in Copenhagen, Denmark, and colleagues. "Whether these benefits can be achieved by both ...ALA (18:3n-3) and n-3 [LC-PUFA] is debatable. The objective was to examine the association between ALA intake and risk of IHD in healthy subjects and to see if this was modified by intake of n-3 LC-PUFA or ...LA (18:2n-6)."

During a median follow-up period of 23.3 years, 471 cases of IHD were observed among 3277 healthy Danish women and men who were free of known IHD at baseline. In women as well as in men, higher ALA intake was not significantly associated with a decreased risk for IHD. With increasing ALA intake in men, the hazard ratio (HR) of IHD was stepwise decreased with increasing ALA intake in men, but this change was far from significant. In the medium vs the lowest (reference) tertile, the HR was 0.84 (95% confidence interval [CI], 0.62 - 1.14). In the highest vs the lowest tertile, the HR was 0.83 (95% CI, 0.56 - 1.24; P for trend = .39). There was no apparent effect modification by n-3 LC-PUFA or LA.

Compared with low intake of n-3 LC-PUFA, high intake was inversely associated with the risk for IHD. Among women, this trend was significant (P = .04; HR, 0.62; 95% CI, 0.40 - 0.97) but not among men (P = 0.15; HR, 0.74; 95% CI, 0.51 - 1.06). There were no apparent associations between LA intake and IHD risk.

"This study suggests that there is no association between ALA intake and risk of IHD, but a high intake of n-3 LC-PUFA had a significant cardioprotective effect in women," the study authors write.

Limitations of this study include errors in the assessment of PUFA intake; possible confounding; and lack of significance in the HR for IHD related to n-3 LC-PUFA intake in men, which may be from a limitation in power. The limited number of days in the weighed food record may have caused overestimation or underestimation of intake of more rarely eaten foods, namely fish.

"On the basis of our results we therefore conclude that higher intake of n-3 LC-PUFA, but not ALA (and LA), reduced the risk of IHD among a representative subgroup of Danish women and men," the study authors conclude. "Further larger studies are warranted to examine potential effect modification by different PUFA."

The Danish Council for Strategic Research supported this study. The study authors have disclosed no relevant financial relationships.

Am J Clin Nutr. Published online August 24, 2011.

Study Highlights

  • Cohorts included from the Glostrup Population Studies were participants born in 1914 and examined in 1974 or 1984; those born in 1936 and examined in 1976, 1981, and 1987; participants born in 1922, 1932, 1942, and 1952, and examined in 1982; and those born in 1932, 1942, 1952, and 1962, and examined in 1991.
  • Inclusion criteria were available data on dietary intake at baseline from 7-day weighed food records and intake of n-3 and n-6 PUFA.
  • Exclusion criteria were prior IHD diagnosis, diabetes mellitus, and missing data on confounders.
  • 3277 healthy Danish men and women without IHD comprised the study sample.
  • 1634 were men, and 1643 were women.
  • All participants were between 30 and 70 years old at the baseline examination visit.
  • The 7-day weighed food record included approximately 100 food items divided into categories of dairy products, bread and cereals, fats, cold cuts, vegetables, meat, drinks, fruit, and miscellaneous.
  • Intake of ALA, n-3 LC-PUFA, and LA was reported in grams per day.
  • Categories of daily ALA intake in women were low (0.27 - 1.03 g), medium (1.03 - 1.49 g), or high (1.49 - 4.32 g). In men, they were low (0.39 - 1.36 g), medium (1.37 - 1.91 g), or high (1.91 - 10.6 g).
  • Categories of daily n-3 LC-PUFA intake in women were low (0 - 0.20 g), medium (0.20 - 0.45 g), or high (0.45 - 11.2 g). In men, they were low (0 - 0.26 g), medium (0.26 - 0.56 g), or high (0.56 - 10.8 g).
  • Categories of daily LA intake in women were low (1.76 - 6.72 g), medium (6.73 - 10.4 g), or high (10.4 - 54.5 g). In men, they were low (2.05 - 9.09 g), medium (9.10 - 13.5 g), or high (13.5 - 74.4 g).
  • The median daily ALA intake was 1.2 g in women and 1.6 g in men.
  • Fatal and nonfatal IHD events were defined by International Classification of Diseases (8th and 10th revisions) diagnosis codes and identified by the National Patient Registry and the Cause of Death Registry.
  • The observation time started with the baseline examination and dietary data collection and ended with any IHD event, death from other causes, emigration, or December 31, 2006.
  • The median follow-up period was 23.3 years.
  • 471 cases of IHD were identified.
  • Analysis adjusted for smoking, education, a family history of acute myocardial infarction, systolic blood pressure, alcohol intake, total energy intake, physical activity, and body mass index.
  • Higher ALA intake was not significantly linked with decreased IHD risk in women or men.
  • The findings for ALA intake and IHD risk were not modified by n-3 LC-PUFA or LA.
  • High vs low intake of n-3 LC-PUFA was linked with a lower risk for IHD in women (HR, 0.62; P = .04) but not in men (HR, 0.74; P = .15).
  • High vs low intake of LA was not linked with a lower risk for IHD in men or women.
  • Study limitations include record of food intake for only 7 days and possible inadequate power to detect effect modification by n-3 LC-PUFA and LA intake.

Clinical Implications

  • Higher ALA intake is not associated with a decreased risk for IHD in women or men, and this effect is not modified by intake of n-3 LC-PUFA or LA.
  • High intake of n-3 LC-PUFA is associated with a lower risk for IHD in women, but not in men. LA intake is not associated with IHD risk.

CME Test

To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Questions answered incorrectly will be highlighted.

According to the study, which of the following most accurately describes the association between ALA intake and IHD risk?
High ALA intake is linked with an increased risk for IHD
High ALA intake is linked with a decreased risk for IHD in women
High ALA intake is not linked with a risk for IHD
High ALA intake is linked with an increased risk for IHD if n-3 LC-PUFA intake is also high
High ALA intake is linked with an increased risk for IHD if LA intake is also high
An adult patient is interested in nutrition to prevent IHD. Which of the following statements on intake of n-3 LC-PUFA and LA is most accurate?
High intake of n-3 LC-PUFA is linked with a lower risk for IHD in women
High intake of n-3 LC-PUFA is linked with a lower risk for IHD in men
High intake of LA is linked with a lower risk for IHD in women
High intake of LA is linked with a lower risk for IHD in men
None of the above

[CLOSE WINDOW]

Authors and Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Author(s)

Laurie Barclay, MD

Freelance writer and reviewer, Medscape, LLC

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Editor(s)

Brande Nicole Martin

CME Clinical Editor, Medscape, LLC

Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.

CME Author(s)

Penny Murata, MD

Clinical Professor, Pediatrics, University of California, Irvine, California
Pediatric Clerkship Director, University of California, Irvine, California

Disclosure: Penny Murata, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

[ CLOSE WINDOW ]

CME Information

CME Released: 09/19/2011; Valid for credit through 09/19/2012

Target Audience

This article is intended for primary care clinicians, cardiologists, and other specialists who provide care to persons at risk for ischemic heart disease.

Goal

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Learning Objectives

Upon completion of this activity, participants will be able to:

  1. Report the association between α-linolenic acid intake and the risk for ischemic heart disease and any modifying effect by omega-3 long-chain polyunsaturated fatty acid or linolenic acid intake.
  2. Report whether omega-3 long-chain polyunsaturated fatty acid or linolenic acid intake affects the risk for ischemic heart disease.

Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)

All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Accreditation Statements

For Physicians

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only credit commensurate with the extent of their participation in the activity.

This activity, Medscape Education Clinical Briefs has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2011. Term of approval is for 1 year from this date. Each issue is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of this issue.

Note: Total credit is subject to change based on topic selection and article length.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

AAFP Accreditation Questions

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

Hardware/Software Requirements

To access Medscape Education users will need

  • A computer with an Internet connection.
  • Internet Explorer 6.x or higher, Firefox 2.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser.
  • Adobe Flash Player and/or an HTML5 capable browser may be required for video or audio playback.
  • Occasionally other additional software may be required such as PowerPoint or Adobe Acrobat Reader.
 
 

Medscape Education © 2011 Medscape, LLC

Disclaimer

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on www.medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

Send comments and news tips to news@medscape.net.

Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)

According to your Medscape profile, you will be issued Letter of Completion for this activity. If this is incorrect, please edit your profile

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only credit commensurate with the extent of their participation in the activity.

This activity, Medscape Education Clinical Briefs has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2011. Term of approval is for 1 year from this date. Each issue is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of this issue.

Note: Total credit is subject to change based on topic selection and article length.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

AAFP Accreditation Questions

Contact This Provider

 
 
 
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