Original Investigation
Circulating Omega-3 Fatty Acids and Incident Adverse Events in Patients With Acute Myocardial Infarction

https://doi.org/10.1016/j.jacc.2020.08.073Get rights and content
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Abstract

Background

Dietary omega-3 eicosapentaenoic acid (EPA) has multiple cardioprotective properties. The proportion of EPA in serum phosphatidylcholine (PC) mirrors dietary EPA intake during previous weeks. Circulating EPA in ST-segment elevation myocardial infarction (STEMI) relates to smaller infarct size and preserved long-term ventricular function.

Objectives

The authors investigated whether serum-PC EPA (proxy for marine omega-3 consumption) levels at the time of STEMI were associated with a lower incidence of major adverse cardiovascular events (MACE), all-cause mortality, and readmission for cardiovascular (CV) causes at 3 years’ follow-up. We also explored the association of alpha-linolenic acid (ALA, proxy for vegetable omega-3 intake) with all-cause mortality and MACE.

Methods

The authors prospectively included 944 consecutive patients with STEMI (mean age 61 years, 209 women) undergoing primary percutaneous coronary intervention. We determined serum-PC fatty acids with gas chromatography.

Results

During follow-up, 211 patients had MACE, 108 died, and 130 were readmitted for CV causes. A Cox proportional hazards model adjusted for known clinical predictors showed that serum-PC EPA at the time of STEMI was inversely associated with both incident MACE and CV readmission (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.62 to 0.94, and HR: 0.74; 95% CI: 0.58 to 0.95, respectively, for a 1-standard deviation [SD] increase). Serum-PC ALA was inversely related to all-cause mortality (HR: 0.65; 95% CI: 0.44 to 0.96, for a 1-SD increase).

Conclusions

Elevated serum-PC EPA and ALA levels at the time of STEMI were associated with a lower risk of clinical adverse events. Consumption of foods rich in these fatty acids might improve the prognosis of STEMI.

Key Words

alpha-linolenic acid
eicosapentaenoic acid
MACE

Abbreviations and Acronyms

AA
arachidonic acid
ALA
alpha-linolenic acid
CAD
coronary artery disease
CI
confidence interval
EPA
eicosapentaenoic acid
HR
hazard ratio
MACE
major adverse cardiovascular events
MI
myocardial infarction
PC
phosphatidylcholine
PPCI
primary percutaneous coronary intervention
SD
standard deviation
STEMI
ST-segment-elevation myocardial infarction

Cited by (0)

Dr. Sala-Vila is recipient of the Instituto de Salud Carlos III (ISCIII) Miguel Servet fellowship (grant CPII 17/00029). Dr. Bayés-Genís is supported by ISCIII (PI17/01487, PI18/00256 and PIC18/00014); CIBER Cardiovascular (CB16/11/00403) projects, as a part of the National R&D&I Plan, and it was co-funded by ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF). Part of this work was supported by a grant from the California Walnut Commission, Folsom, California (to Dr. Sala-Vila). The funding agencies had no input in the study design, data collection, analyses, or writing and submission of the manuscript. Dr. Sala-Vila has reported grants and support from the California Walnut Commission to attend professional meetings. Dr. Bayés-Genís has reported personal fees from AstraZeneca, Vifor-Fresenius, Novartis, Boehringer Ingelheim, Abbott, Roche Diagnostics, and Critical Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

Drs Lázaro and Rueda contributed equally to this study.