The effect of omega-3 fatty acids on coronary atherosclerosis quantified by coronary computed tomography angiography

Abstract

Background & aims: Data on the effects omega-3 fatty acids on coronary artery disease (CAD) are contradictory. While a recent metanalysis could not show improved cardiovascular outcomes, antiatherogenic mechanisms are well known. Objective: Aim was to assess the influence of Omega-3 polyunsaturated long-chain fatty acids (PUFA) supplementation on coronary atherosclerosis quantified by coronary computed tomography angiography (CTA). Methods: 106 patients (59.4y± 10.7; 50% females) with low-to-intermediate risk referred to CTA were included. 53 patients under omega 3-PUFA (docosahexaenoic acid, DHA and eicosapentaenoic acid, EPA) supplementation were retrospectively matched with 53 controls (CR) for age, gender and coronary risk profile (smoking, arterial hypertension, family history, dyslipidemia, c-LDL, Cholesterol, TG, diabetes) (1:1, propensity score) and lifestyle habits (exercise, alcohol consumption and nutrition). CTA analysis included 1) stenosis severity score >70%severe, 50e70% moderate, 25e50%mild, <25% minimal), 2) total plaque burden (segment involvement score (SIS) and mixed non-calcified plaque burden (G-score) and 3) high-risk-plaque features (Napkin-Ring-Sign, low attenuation plaque (LAP), spotty calcification<3 mm, RI>1.1). CT-Density (Hounsfield Units, HU) of plaque was quantified by CTA. Results: Prevalence of coronary atherosclerosis (any plaque: 83% vs. 90.6%, p ¼ 0.252), >50% stenosis and stenosis severity score (p ¼ 0.134) were not different between groups. Total and non-calcified plaque burden scores were lower in the omega-3 group (2.7 vs. 3.5, p ¼ 0.08 and 4.5 vs. 7.4, p ¼ 0.027 for SIS and G-score, resp.). Coronary artery calcium score (CACS) was similar (84.7 vs. 87.1AU). High-risk-plaque prevalence was lower in the Omega-3 group (3.8% vs. 32%, p < 0.001); the number of high-risk-plaques (p < 0.001) and Napkin-Ring-Sign prevalence was lower (3.8% vs. 20.9%) (p < 0.001), resp. CT-density (HU) of plaque was higher in the Omega-3 group (131.6 ± 2 vs. 62.1 ± 27, p ¼ 0.02) indicating more fibrous-dense plaque component rather than lipid-rich atheroma. Mean duration of Omega-3 intake was 38.6 ± 52 months (range, 2e240). Conclusions: Omega-3-PUFA supplementation is associated with less coronary atherosclerotic "highrisk" plaque (lipid-rich) and lower total non-calcified plaque burden independent on cardiovascular risk factors. Our study supports direct anti-atherogenic effects of Omega-3-PUFA.

Subclinical cardiovascular disease and utility of coronary artery calcium score

“…A case controlled retrospectively matched cohort study by Feuchtner et al [224] including 53 patients taking Omega-3 supplementation (either DHA or EPA at 1 g) with mean duration of 38.6 ± 52 months and their propensity score matched 53 control participants according to no intergroup difference in age, gender, BMI, conventional risk factors, ASA and statin medications to examine influence of Omega-3 (n-3) polyunsaturated fatty acids (PUFA) on CAD plaque burden assessed by CTA, reported Omega-3 group compared to control group had significantly lower G-score of mixed noncalcified plaque burden (4.5 vs 7.4), lower prevalence of high-risk plaque (HRP) burden (3.8% vs 32%) and lower number HRP-count (3vs23), higher mean intraplaque CT-density of low-attenuated plaque at either HU of region of interest (131.6 vs 62.1) or HU of lens (132 vs 52.1) reflecting more like denser fibro-calcific other than lipid-rich changes, higher spotty calcification (18.8% vs 11.3% or 1 case vs 6 cases) and but lower rate of napkin ring sign (3.7% vs 20.9%) reflecting lipid-rich necrotic core, but stenosis severity remained similar for both groups.…”

Effects of ω-3 PUFA-Rich Oil Supplementation on Cardiovascular Morphology and Aortic Vascular Reactivity of Adult Male Rats Submitted to an Hypercholesterolemic Diet

“…Recent studies have supported the antiatherogenic effects of ω-3 PUFAs [ 14 , 15 ]. Guidelines for CVD prevention in Brazil and worldwide have encouraged the consumption of foods containing ω-3 PUFAs daily as part of healthy eating [ 16 ].…”

Bluetooth-Connected Pocket Spectrometer and Chemometrics for Olive Oil Applications

“…Linoleic acid is an omega-3 essential acid that the human body cannot synthesize and must be up-taken from the diet. It is renowned for helping anti-atherosclerosis and anti-inflammatory mechanisms, and provides protection against neurodegenerative diseases [ 46 , 47 , 48 , 49 ].…”