Higher EPA levels and EPA/DHA Ratios Are associated with Lower Cardiovascular Mortality Post-Myocardial Infarction

Background The efficacy of omega-3 fatty acid supplementation in cardiovascular prevention remains debated. Observational data suggest that individual fatty acids may have distinct prognostic value after acute myocardial infarction (AMI). Objectives To analyze the association of plasma fatty acid (FA) levels including eicosapentaenoic acid (EPA) and the EPA/docosahexaenoic acid (DHA) ratio at the time of AMI with one-year cardiovascular (CV) mortality. Methods and results This prospective study included 572 patients hospitalized for AMI. Plasma FA levels were measured using gas chromatography coupled with mass spectrometry. The associations between FA profiles and CV mortality at one-year follow-up were analyzed using Cox proportional hazards models. At follow-up, 29 deaths were cardiovascular-related. Patients who died had lower relative levels of EPA (0.47% (0.28–0.73) vs. 0.73% (0.52–1.02), p<0.001), a lower EPA/DHA ratio (0.33 (0.22–0.43) vs. 0.44 (0.33–0.61) p<0.001), and more elevated levels of inflammatory biomarkers, including hs-CRP and interleukin-1β. In contrast, DHA levels were not associated with CV mortality. In multivariate analysis, the EPA/DHA ratio was associated with lower CV mortality, even after adjustment for confounding factors including GRACE risk score, left ventricular ejection fraction, and inflammatory biomarkers. Conclusion Our study demonstrates that higher plasma levels of EPA and EPA/DHA ratio are associated with lower CV mortality one year after AMI.