Hormonal
Higher intake of intermediate-chain n-3 PUFAs (ALA) from plant sources reduces the risk of nonfatal myocardial infarction and total coronary heart disease, but this benefit is primarily observed when long-chain n-3 (EPA+DHA) intake is very low (<100 mg/d).
If you do not eat fatty fish (keeping long-chain omega-3s under 100 mg/day), make sure you get plenty of plant-based omega-3s (ALA) from sources like flaxseeds, chia seeds, or walnuts. For every 1 gram of ALA you consume daily, your risk of a non-fatal heart attack drops significantly. This is your primary nutritional lever for heart protection if you avoid fish.
Among men with very low EPA+DHA intake (<100 mg/d), each 1 g/d of intermediate-chain n-3 PUFA (ALA) intake was associated with a 58% lower risk of nonfatal MI (HR=0.42; 95% CI=0.23 to 0.75) and a 47% lower risk of total CHD (HR=0.53; 95% CI=0.34 to 0.83).
Why this rating
Large prospective cohort with strong statistical interaction (P=0.003) confirming the conditional nature of the effect.
Source
Interplay Between Different Polyunsaturated Fatty Acids and Risk of Coronary Heart Disease in Men
Dariush Mozaffarian et al. · Circulation · 2005
DOI 10.1161/01.cir.0000152099.87287.83
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