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Review
. 2014 Nov 14;5(6):863S-76S.
doi: 10.3945/an.114.005850. Print 2014 Nov.

The Evidence for α-Linolenic Acid and Cardiovascular Disease Benefits: Comparisons With Eicosapentaenoic Acid and Docosahexaenoic Acid

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Free PMC article
Review

The Evidence for α-Linolenic Acid and Cardiovascular Disease Benefits: Comparisons With Eicosapentaenoic Acid and Docosahexaenoic Acid

Jennifer A Fleming et al. Adv Nutr. .
Free PMC article

Abstract

Our understanding of the cardiovascular disease (CVD) benefits of α-linolenic acid (ALA, 18:3n-3) has advanced markedly during the past decade. It is now evident that ALA benefits CVD risk. The expansion of the ALA evidence base has occurred in parallel with ongoing research on eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) and CVD. The available evidence enables comparisons to be made for ALA vs. EPA + DHA for CVD risk reduction. The epidemiologic evidence suggests comparable benefits of plant-based and marine-derived n-3 (omega-3) PUFAs. The clinical trial evidence for ALA is not as extensive; however, there have been CVD event benefits reported. Those that have been reported for EPA + DHA are stronger because only EPA + DHA differed between the treatment and control groups, whereas in the ALA studies there were diet differences beyond ALA between the treatment and control groups. Despite this, the evidence suggests many comparable CVD benefits of ALA vs. EPA + DHA. Thus, we believe that it is time to revisit what the contemporary dietary recommendation should be for ALA to decrease the risk of CVD. Our perspective is that increasing dietary ALA will decrease CVD risk; however, randomized controlled clinical trials are necessary to confirm this and to determine what the recommendation should be. With a stronger evidence base, the nutrition community will be better positioned to revise the dietary recommendation for ALA for CVD risk reduction.

Conflict of interest statement

Author disclosures: P. M. Kris-Etherton serves on the Advisory Board of and has received grant support from the California Walnut Commission. J. A. Fleming, no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Enzymatic conversion of LA to longer-chain n–6 PUFAs and ALA to longer-chain n–3 PUFAs. ALA, α-linolenic acid; AA, arachidonic acid; DGLA, dihomo-γ-linolenic acid; DPA, docosapentaenoic acid; GLA, γ-linolenic acid; LA, linoleic acid.
FIGURE 2
FIGURE 2
(Top) Multivariable risk ratios of sudden cardiac death by dietary intake of n–3 and n–6 PUFAs among women in the Nurses’ Health Study (bottom) quintile of fatty acid intake as % of total fat. AA, arachidonic acid; ALA, α-linolenic acid; LA, linoleic acid; Q, quintile. Adapted from reference with permission.

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