*Article* **Omega-3 Fatty Acids in Erythrocyte Membranes as Predictors of Lower Cardiovascular Risk in Adults without Previous Cardiovascular Events**

**Gustavo Henrique Ferreira Gonçalinho, Geni Rodrigues Sampaio, Rosana Aparecida Manólio Soares-Freitas and Nágila Raquel Teixeira Damasceno \***

> Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; ghfg93@gmail.com (G.H.F.G.); genirs@usp.br (G.R.S.); rosanaso@usp.br (R.A.M.S.-F.) **\*** Correspondence: nagila@usp.br; Tel.: +55-11-3061-7865; Fax: +55-11-3061-7721

**Abstract:** *Background:* This study investigated the association of omega-3 polyunsaturated fatty acids (*n*-3 PUFA) within erythrocyte membranes and cardiovascular risk assessed by three different estimates. *Methods:* Inclusion criteria were individuals of both sexes, 30 to 74 years, with at least one cardiovascular risk factor, and no previous cardiovascular events (*n* = 356). Exclusion criteria were individuals with acute or chronic severe diseases, infectious diseases, pregnant, and/or lactating women. Plasma biomarkers (lipids, glucose, and *C*-reactive protein) were analyzed, and nineteen erythrocyte membrane fatty acids (FA) were identified. The cardiovascular risk was estimated by Framingham (FRS), Reynolds (RRS), and ACC/AHA-2013 Risk Scores. Three patterns of FA were identified (Factor 1, poor in *n*-3 PUFA), (Factor 2, poor in PUFA), and (Factor 3, rich in *n*-3 PUFA). *Results:* Total cholesterol was inversely correlated with erythrocyte membranes C18:3 *n*-3 (r = −0.155; *p* = 0.004), C22:6 *n*-3 (r = −0.112; *p* = 0.041), and total *n*-3 (r = −0.211; *p* < 0.001). Total *n*-3 PUFA was associated with lower cardiovascular risk by FRS (OR = 0.811; 95% CI= 0.675–0.976). Regarding RRS, Factor 3 was associated with 25.3% lower odds to have moderate and high cardiovascular risk (OR = 0.747; 95% CI = 0.589–0.948). The ACC/AHA-2013 risk score was not associated with isolated and pooled FA. *Conclusions: n*-3 PUFA in erythrocyte membranes are independent predictors of low-risk classification estimated by FRS and RRS, which could be explained by cholesterol-lowering effects of *n*-3 PUFA.

**Keywords:** *n*-3 polyunsaturated fatty acids; cardiovascular risk estimates; cardiovascular diseases; biomarkers; cardiovascular risk factors
