Secular Decreasing Trend in Plasma Eicosapentaenoic and Docosahexaenoic Acids among Patients with Acute Coronary Syndrome from 2011 to 2019: A Single Center Descriptive Study

Abstract

Despite intensive lipid-lowering interventions, patients treated with statins develop atherosclerotic cardiovascular disease (ASCVD), and these patients have an increased risk of developing recurrent cardiovascular events during follow-up. Therefore, there is a need to focus on the residual risks in patients in statin therapy to further reduce ASCVD. The aim of this study was to retrospectively investigate the 10-year trend (2011–2019) regarding changes in polyunsaturated fatty acids (PUFAs) in patients with acute coronary syndrome (ACS) in a single center. We included 686 men and 203 women with ACS admitted to Kagawa Prefectural Central Hospital. Plasma PUFAs, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), and dihomo-γ-linolenic acid (DGLA), were measured at admission for suspected ACS. A secular decreasing trend in the levels of EPA and DHA and the EPA/AA ratio, but not of AA and DGLA, was observed. The analyses based on age (>70 or <70 years) and sex showed that the decreasing trend in the levels of EPA and DHA did not depend on age and remained significant only in men. Further studies are needed to obtain robust evidence to justify that the administration of n-3 PUFA contributes to the secondary prevention of ACS.

Changes in the Eicosapentaenoic Acid to Arachidonic Acid Ratio in Serum over 10 Years in a Japanese Community: The Hisayama Study

“…Increasing trends in serum AA concentrations were consistently observed in the present study and the previous studies of Japanese populations 24,25) . A study in Japanese community dwellers demonstrated an increase in serum AA concentrations from approximately 150 μg/mL to ＞200 μg/mL 24) , which were comparable to the levels in the present study.…”

“…We demonstrated a decrease in the serum EPA/ AA ratio over time in the analyzed population as a whole. In agreement with this observation, a previous study in 889 Japanese patients hospitalized with suspected acute coronary syndrome also demonstrated a decrease in the serum EPA/AA ratio over 10 years 25) . Another study in Japan demonstrated that serum AA concentrations increased from 2006 to 2012 among 878 community dwellers, while serum EPA concentrations were unchanged, and the serum EPA/ AA ratio was not reported 24) .…”

“…We observed that serum EPA concentrations increased slightly in the whole population but not in those aged between 40 and 69 years. A study on acute coronary syndrome patients also reported a decrease in plasma EPA concentrations regardless of age 25) . In contrast, in the study mentioned above of community dwellers, the 36) .…”

“…Evidence shows marked and continuous Westernization since the 2000s, characterized by increasing meat consumption and decreasing fish consumption 23) . Therefore, a decline in the omega-3 to omega-6 fatty acid ratio over time can be anticipated, but data on changes in the circulating EPA/AA ratio at a population level across time are limited 24,25) .…”

Nutrition and Cardiovascular Diseases

“…In acute coronary syndrome (ACS), Okada et al [ 8 ] have found a decreasing trend in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels, and EPA to arachidonic acid ratio in men from 2011 to 2019 without significant changes in low-density lipoprotein and high-density lipoprotein cholesterol levels, in which decreasing trend in EPA and DHA levels did not depend on age and was significant only in men in patients with ACS. Administration of a sufficient dose of n-3 polyunsaturated fatty acids may be effective in the secondary prevention of ACS, but further studies are needed to obtain robust evidence.…”