Omega-3 blood levels and stroke risk: A pooled and harmonized analysis of 183 291 participants from 29 prospective studies

O'Keefe, James H.; Sala Vila, Aleix; Lázaro, Iolanda; Mozaffarian, Dariush

doi:http://dx.doi.org/10.1161/STROKEAHA.123.044281

Omega-3 blood levels and stroke risk: A pooled and harmonized analysis of 183 291 participants from 29 prospective studies

Citation

O'Keefe JH, Tintle NL, Harris WS, O'Keefe EL, Sala-Vila A, Attia J, et al. Omega-3 blood levels and stroke risk: A pooled and harmonized analysis of 183 291 participants from 29 prospective studies. Stroke. 2024 Jan;55(1):50-8. DOI: 10.1161/STROKEAHA.123.044281

Abstract

Background: The effect of marine omega-3 PUFAs on risk of stroke remains unclear. Methods: 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. Results: 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]; P<0.0001), and ischemic stroke was 18% lower (HR, 0.82 [CI, 0.74-0.91]; P<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]; P=0.0001) and a 14% lower incidence of ischemic stroke (HR, 0.86 [CI, 0.78-0.95]; P=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. Conclusions: Higher omega-3 PUFA levels are associated with lower risks of total and ischemic stroke but have no association with hemorrhagic stroke.