Pentadecanoic acid (C15:0) and cardiovascular disease: A narrative review

Figure 1 Age-adjusted cardiovascular disease mortality rate in the United States (1900-2024). Age-adjusted cardiovascular mortality in the United States fell steeply after 1960 but rebounded during the coronavirus disease 2019 era, underscoring the persistent public-health burden of heart disease. COVID-19: Coronavirus disease 2019; CVD: Cardiovascular disease.

Figure 2 Dietary and metabolic flow of pentadecanoic acid (C15:0). Major exogenous pathway for pentadecanoic acid: Microbial synthesis in ruminants yields C15:0-rich milk fat that, once ingested, produces characteristic circulating C15:0 signatures usable as objective dairy-intake biomarkers. OCSFAs: Odd-chain saturated fatty acids.

Figure 3 Prospective evidence linking circulating C15:0 to cardiovascular events. Pooled analysis of 18 prospective cohorts shows a 12% lower risk of incident cardiovascular disease among participants in the highest quintile of circulating C15:0 compared with the lowest, with minimal between-study heterogeneity (I² = 14%). HR: Hazard ratio.

Figure 4 Integrated mechanistic map of C15:0 cardioprotection. Pentadecanoic acid engages lipid, inflammatory, metabolic and mitochondrial pathways that collectively attenuate atherosclerosis and improve cardiometabolic health. AMPK: AMP-activated protein kinase; MCP-1: Monocyte chemoattractant protein-1; PPAR-α/δ: Peroxisome proliferator-activated receptors alpha and delta; GLUT4: Glucose transporter type 4.