Monounsaturated Fatty Acids in Adipose Tissue and the Risk of Peripheral Artery Disease: A Danish Case-Cohort study

• Recent data have linked MUFAs with a higher risk of vascular disease contradictory to current dietary guidelines. • Individual MUFAs may exert differential effects on the initiation and progression of atherosclerosis. • This study showed that several MUFAs in adipose tissue were associated with a higher risk of peripheral artery disease. • Our findings suggest that MUFAs may differ in their properties and future studies should focus on their individual effects and origin. Recent data have linked MUFAs with a higher risk of vascular disease contradictory to current dietary guidelines. Individual MUFAs may exert differential effects on the initiation and progression of atherosclerosis. This study showed that several MUFAs in adipose tissue were associated with a higher risk of peripheral artery disease. Our findings suggest that MUFAs may differ in their properties and future studies should focus on their individual effects and origin. Dietary guidelines recommend replacing saturated fatty acids with poly- or monounsaturated fatty acids (MUFA) to lower the risk of cardiovascular disease. The biological effects of MUFAs may differ between individual MUFAs, while their role in development of peripheral artery disease (PAD) remains unknown. We investigated associations between the content of MUFAs in adipose tissue and the risk of incident PAD. We conducted a case-cohort study within the Danish Diet, Cancer and Health cohort (n = 57,053). Gluteal adipose tissue biopsies were obtained from all participants, in a random sample of 5000 participants, and in all PAD cases, and analysed for MUFA content by gas chromatography. Hazard ratios (HR) for PAD were estimated using weighted Cox proportional hazard regression. During a median follow-up of 20.6 years, 1,850 PAD cases were identified among 54,057 eligible participants. Comparing the highest quintile with the lowest, adipose tissue content of total MUFAs (HR: 1.40; 95% CI: 1.13-1.75), and the individual MUFAs 16:1ω7 (HR: 1.69; 95% CI: 1.36-2.10), and 18:1ω7 (HR: 2.48; 95% CI: 1.95-3.16) were associated with a higher risk of PAD, while no clear association was found for 20;1w9, 14:1ω5, 20:1ω11 and 18:1ω9. Adipose tissue content of total MUFAs and of 18:1ω7 and 16:1ω7 were associated with a higher risk of PAD, while findings were less clear for other MUFAs. Our findings show that not all MUFAs are equal and that future studies also should focus on individual MUFAs and their origin.