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Background: Animal models have shown that adipose-derived palmitoleic acid may act as a lipokine by conferring resistance to diet-induced obesity; however, human epidemiologic studies investigating this relationship thus far have not provided data in support of this hypothesis. Because metabolic syndrome and cardiovascular disease are intricately linked with the former being a major risk factor for the latter, we hypothesized that adipose-derived palmitoleic acid may be inversely associated with myocardial infarction.Objective: We examined whether adipose tissue palmitoleic acid was associated with nonfatal acute myocardial infarction in a representative population of Costa Rican adults.Methods: Odds ratios of nonfatal acute myocardial infarction by quintiles of adipose tissue palmitoleic acid were calculated using conditional logistic regression in a case-control study of 1,828 cases and 1,828 controls matched by age, sex, and area of residence.Results: We observed an inverse relationship between nonfatal acute myocardial infarction and adipose tissue palmitoleic acid (OR for highest quintile compared to lowest quintile of palmitoleic acid: 0.54; 95% CI: 0.37, 0.79; P for trend: 0.0007). We additionally observed a significant positive association between adipose tissue palmitoleic acid and high-density lipoprotein (HDL) cholesterol, an important cardiometabolic risk factor for myocardial infarction.Conclusions: These data support the conclusion that adipose-derived palmitoleic acid may behave as a lipokine in the context of human myocardial infarction. This protective association may be partially explained by the increase in HDL cholesterol across quartiles of palmitoleic acid in our population of Costa Rican adults.