The ratio of eicosapentaenoic acid to arachidonic acid is a critical risk factor for acute coronary syndrome in middle-aged older patients as well as younger adult patients

Serikawa, Takeshi; Miura, Shin‐ichiro; Okabe, Masaru; Hongo, Hiroshi; Tokutome, Masaki; Yoshikawa, Tomohiro; Takesue, Ko; Adachi, Sen; Osaka, Kunpei; Matsukawa, Ryuichi; Yanagi, Daizaburo; Nozoe, Masafumi; Kozai, Toshiyuki; Hironaga, Kiyoshi; Saku, Keijiro; Yamamoto, Yusuke

doi:10.1016/j.jjcc.2013.06.016

Cited by 19 publications

(13 citation statements)

References 49 publications

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“…A previous report has indicated that AA levels in smokers (mean age, 50 years) are decreased [17], which is inconsistent with the findings of our study; however, another report indicated that AA in smokers are not decreased [18]. Of note, the metabolism of AA is not always parallel to that of EPA [19–21], and compared to EPA, smoking has been shown to delay the conversion rate of AA to eicosanoids [22]. These findings may support an impairment of EPA/AA balance, namely, a decrease in the EPA/AA ratio, observed among smokers in our study.…”

Section: Discussioncontrasting

confidence: 99%

Eicosapentaenoic acid/arachidonic acid ratio and smoking status in elderly patients with type 2 diabetes mellitus

Okada

Kotani

Yagyu

et al. 2014

Diabetol Metab Syndr

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BackgroundA low ratio of eicosapentaenoic acid (EPA)/arachidonic acid (AA) is considered a risk factor for cardiovascular disease. Smoking is also a risk factor for cardiovascular disease even in an elderly population. This study investigated the relationship between EPA/AA ratio and smoking status among elderly patients with type 2 diabetes mellitus (T2DM).FindingsA total of 188 elderly patients with T2DM (men/women, 114/74; mean age, 65.0 ± 7.5 years) were studied in terms of their smoking status, diabetic conditions, and blood data, including EPA and AA. Current smokers showed a lower EPA/AA ratio than non-smokers (current smokers: 0.29, n = 49; non-smokers: 0.39, n = 139, p < 0.01). This relationship remained significant after adjusting for multiple variables.ConclusionsSmoking may affect the EPA/AA ratio among elderly patients with T2DM, suggesting a possible mechanism of cardiovascular disease development and indicating the importance of smoking secession in such patients.

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Section: Discussioncontrasting

confidence: 99%

Eicosapentaenoic acid/arachidonic acid ratio and smoking status in elderly patients with type 2 diabetes mellitus

Okada

Kotani

Yagyu

et al. 2014

Diabetol Metab Syndr

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“…In patients with angina pectoris who received statins for 8 months after PCI, the EPA/AA ratio was negatively correlated with the percentage change from baseline in both plaque volume (r ¼ À0.19; P ¼ 0.05) and plaque fibrous component volume (r ¼ À0.21; P ¼ 0.04) [75]. A low EPA/AA ratio was identified as an independent risk factor for ACS in patients !50 years of age as well as in younger adults [76]. In ACS patients assessed by optical coherence tomography, a low EPA/AA ratio was associated with vulnerable coronary plaque morphology, showing a significant correlation with fibrous cap thickness (r ¼ 0.37; P ¼ 0.002) [77].…”

Section: Effects Of Epa On Inflammation and Cytokinesmentioning

confidence: 95%

Biologic plausibility, cellular effects, and molecular mechanisms of eicosapentaenoic acid (EPA) in atherosclerosis

Borow¹,

2015

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Residual cardiovascular (CV) risk remains in dyslipidemic patients despite intensive statin therapy, underscoring the need for additional intervention. Eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid, is incorporated into membrane phospholipids and atherosclerotic plaques and exerts beneficial effects on the pathophysiologic cascade from onset of plaque formation through rupture. Specific salutary actions have been reported relating to endothelial function, oxidative stress, foam cell formation, inflammation, plaque formation/progression, platelet aggregation, thrombus formation, and plaque rupture. EPA also improves atherogenic dyslipidemia characterized by reduction of triglycerides without raising low-density lipoprotein cholesterol. Other beneficial effects of EPA include vasodilation, resulting in blood pressure reductions, as well as improved membrane fluidity. EPA's effects are at least additive to those of statins when given as adjunctive therapy. In this review, we present data supporting the biologic plausibility of EPA as an anti-atherosclerotic agent with potential clinical benefit for prevention of CV events, as well as its cellular effects and molecular mechanisms of action. REDUCE-IT is an ongoing, randomized, controlled study evaluating whether the high-purity ethyl ester of EPA (icosapent ethyl) at 4 g/day combined with statin therapy is superior to statin therapy alone for reducing CV events in high-risk patients with mixed dyslipidemia. The results from this study are expected to clarify the role of EPA as adjunctive therapy to a statin for reduction of residual CV risk.

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“…Indeed, the EPA:AA ratio has been shown to be a critical risk factor for ACS. In a study of patients who underwent coronary angiography, a lower EPA:AA ratio was found to be a strong independent risk factor for ACS (odds ratio, 0.37; P = 0.023) [28]. In a second study, a lower EPA:AA ratio correlated with age at the time of ACS onset in patients who were admitted for PCI, suggesting that this ratio is a predictive risk factor for early onset of ACS [61].…”

Section: Acute Coronary Syndromementioning

confidence: 99%

The eicosapentaenoic acid:arachidonic acid ratio and its clinical utility in cardiovascular disease

Nelson

Raskin²

2019

Postgraduate Medicine

116

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Eicosapentaenoic acid (EPA) is a key anti-inflammatory/anti-aggregatory long-chain polyunsaturated omega-3 fatty acid. Conversely, the omega-6 fatty acid, arachidonic acid (AA) is a precursor to a number of pro-inflammatory/pro-aggregatory mediators. EPA acts competitively with AA for the key cyclooxygenase and lipoxygenase enzymes to form less inflammatory products. As a result, the EPA:AA ratio may be a marker of chronic inflammation, with a lower ratio corresponding to higher levels of inflammation. It is now well established that inflammation plays an important role in cardiovascular disease. This review examines the role of the EPA:AA ratio as a marker of cardiovascular disease and the relationship between changes in the ratio (mediated by EPA intake) and changes in cardiovascular risk. Epidemiological studies have shown that a lower EPA:AA ratio is associated with an increased risk of coronary artery disease, acute coronary syndrome, myocardial infarction, stroke, chronic heart failure, peripheral artery disease, and vascular disease. Increasing the EPA:AA ratio through treatment with purified EPA has been shown in clinical studies to be effective in primary and secondary prevention of coronary artery disease and reduces the risk of cardiovascular events following percutaneous coronary intervention. The EPA:AA ratio is a valuable predictor of cardiovascular risk. Results from ongoing clinical trials will help to define thresholds for EPA treatment associated with better clinical outcomes.

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The ratio of eicosapentaenoic acid to arachidonic acid is a critical risk factor for acute coronary syndrome in middle-aged older patients as well as younger adult patients

Abstract: Lower level of EPA/AA is a common critical risk factor for ACS in middle-aged older patients as well as younger adult patients. Some of the risk factors for the onset of ACS in younger patients were different from those in older patients.

Cited by 19 publications

References 49 publications

Eicosapentaenoic acid/arachidonic acid ratio and smoking status in elderly patients with type 2 diabetes mellitus

Eicosapentaenoic acid/arachidonic acid ratio and smoking status in elderly patients with type 2 diabetes mellitus

Biologic plausibility, cellular effects, and molecular mechanisms of eicosapentaenoic acid (EPA) in atherosclerosis

The eicosapentaenoic acid:arachidonic acid ratio and its clinical utility in cardiovascular disease

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