Low levels of serum n-3 polyunsaturated fatty acids are associated with worse heart failure-free survival in patients after acute myocardial infarction

Background: Intake of long-chain n-3 polyunsaturated fatty acids (n-3 PUFA), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), is associated with a lower risk of atherosclerotic cardiovascular events, particularly acute myocardial infarction (AMI). However, limited data are available regarding the association between serum n-3 PUFA levels and heart failure (HF) events in survivors of AMI. Methods and Results: We evaluated whether serum DHA and EPA levels were associated with HF-free survival and HF hospitalization rates after AMI. A total of 712 patients were divided into 3 groups according to their tertile serum levels of DHA and EPA (Low, Middle, and High). Propensity-score-stratified Cox regression analysis revealed that DHA- and EPA-Low groups presented statistically significant worse HF-free survival (hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.03-2.72, P=0.0358, and HR 1.69, 95% CI 1.05-2.72, P=0.0280, respectively), with the EPALow group having a higher risk of HF hospitalization (HR 2.40, 95% CI 1.21-4.75, P=0.0097) than the DHA-Low group (HR 1.72, 95% CI 0.86-3.45, P=0.1224). The relationship between a low DHA or EPA level and decreased HF-free survival was almost common to all subgroups; however, the effect of low serum EPA on HF hospitalization was prominent in male patients, and those with low levels of high-density lipoprotein cholesterol or without statin therapy. Conclusions: Low levels of circulating n-3 PUFA are associated with decreased HF-free survival in post-AMI patients.Masahiko Hara, Yasuhiko Sakata, Daisaku Nakatani, Shinichiro Suna, Masaya Usami, Sen Matsumoto, Toshimitsu Hamasaki, Yasuji Doi, Masami Nishino, Hiroshi Sato, Tetsuhisa Kitamura, Shinsuke Nanto, Masatsugu Hori, Issei Komuro, for the Osaka Acute Coronary Insufficiency Study (OACIS) Investigators, Low Levels of Serum n-3 Polyunsaturated Fatty Acids Are Associated With Worse Heart Failure-Free Survival in Patients After Acute Myocardial Infarction, Circulation Journal, 2013, Volume 77, Issue 1, Pages 153-162, Released December 25, 2012, [Advance publication] Released October 06, 2012, Online ISSN 1347-4820, Print ISSN 1346-9843, https://doi.org/10.1253/circj.CJ-12-0875, https://www.jstage.jst.go.jp/article/circj/77/1/77_CJ-12-0875/_article/-char/e