Serum N-3 Polyunsaturated Fatty Acid Levels Correlate With the Extent of Coronary Plaques and Calcifications in Patients With Acute Myocardial Infarction

Abstract

rogression of coronary atherosclerosis and rupture of unstable plaque are key processes in acute myocardial infarction (AMI). The extent of coronary artery disease has been well documented as a major prognostic factor in patients with AMI. Prevention and evaluation of the progression of atherosclerotic plaque volume is thus essential to both reduce cardiac events and estimate prognosis after AMI.Evidence that supplementation with n-3 polyunsaturated fatty acids prevents atherosclerosis-related cardiovascular risk has been accumulating. 1,2 More recently, a large randomized study demonstrated that eicosapentaenoic acid (EPA) is effective in preventing major coronary events in patients with hyperlipidemia. 3 Dysfunction of the vascular endothelium, fatty streak formation and fibrous cap formation are processes in the formation of atherosclerotic lesions that are regulated by the action of vasoactive molecules, growth factors, cytokines, and lipid metabolites. Several studies have demonstrated that supplementation with n-3 polyunsaturated fatty acids attenuates the exaggerated platelet aggregation induced by various stimuli, 4,5 attenuates the action of growth factors and cytokines, 5-7 reduces the serum triglyceride concentration, 8,9 and increases high-density lipoprotein levels. 8 There are several methods of evaluating coronary atherosclerotic lesions. Coronary angiography is widely used as the gold-standard to determine coronary stenosis, but it can only detect a luminal reduction in stenosis, collateral patterns and the presence of dense calcification of the coronary arteries, not plaque quantity. Coronary angioscopy and intravascular ultrasound (IVUS) can provide information about plaque characteristics to some extent, 10-14 but the observation areas are somewhat restricted and the methods are quite invasive. Multidetector spiral computed tomography (MDCT) with high slice numbers is now providing sufficient time and spatial resolution power to detect coronary atherosclerosis. 15,16 Its reliability in the determination of coronary plaque morphology has been recently demonstrated by studies using IVUS and histopathologic studies. 17,18 The advantages of MDCT are that it is relatively noninvasive compared with intracoronary angioscopy and IVUS, and has sufficient stability for observation of the entire coronary tree. Indeed, at present, MDCT is thought to be 1 of the best methods of evaluating coronary plaque characteristics.Based on these lines of evidence, we hypothesized that serum n-3 polyunsaturated fatty acid levels would correlate with the extent of coronary atherosclerotic lesions. The Background The relationship between serum fatty acid levels and the extent of coronary plaques and calcification was examined in patients with acute myocardial infarction (AMI). Methods and ResultsThe serum levels of the n-3 polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) and the n-6 polyunsaturated fatty acids (arachidonic acid (AA) and dihomogamma-linolenic acid (DGLA)) were det...

An Increase in the EPA/AA Ratio is Associated with Improved Arterial Stiffness in Obese Patients with Dyslipidemia

“…Previous epidemiological studies reported that high n-3/n-6 PUFA levels and the EPA/ AA ratio are associated with a low rate of ischemic heart disease 12,13) . In addition, a sub-analysis of the JELIS and other studies suggested that a high serum EPA/AA ratio is significantly associated with a low incidence of cardiac death or myocardial infarction, and a low coronary plaque score 14,15) . We also showed that the serum EPA/AA ratio in obese patients is associated with monocyte expression of IL-10, an antiinflammatory M2 marker 16) .…”

“…In serum, most fatty acids are esterified in cholesterol and TG (or phospholipids), and these lipids are incorporated in lipoproteins such as VLDL and LDL, while a small part of the fatty acids are in a non-esterified (free) form and are bound to albumin. The composition of serum fatty acids was determined by capillary gas chromatography 14,15) . The esterified and non-esterified (free) fatty acids of the serum total lipids were transesterified with methanolic hydrochloric acid.…”

Dipeptidyl‐peptidase IV inhibitor is effective in patients with type 2 diabetes with high serum eicosapentaenoic acid concentrations

“…Evidence that fish intake prevents atherosclerosis‐related cardiovascular disease have been accumulating 10,11 . A recent study has shown a significant inverse correlation between serum EPA or DHA concentrations and cardiovascular risk 12 . Furthermore, some studies showed that fish intake reduced the rates of incidence for diabetes in patients with metabolic syndrome, and reduced the rates of death in patients with type 2 diabetes 13,14 .…”

Association Between Serum Levels of n-3 Polyunsaturated Fatty Acids and Coronary Plaque Detected by Coronary Computed Tomography Angiography in Patients Receiving Statin Therapy

“…Ueeda et al reported that serum EPA levels were significantly associated with the extent of coronary plaques in patients with acute myocardial infarction. 30 The presence of high-risk coronary plaques (ie, LDP+PR) was associated with low serum EPA levels in the present EPA. These results suggest that even after at least 6 months of statin therapy, there remains a residual risk for coronary atherosclerotic progression that leads to future cardiovascular events, including ACS.…”