Key result
Elevated serum-PC EPA at the time of STEMI was associated with a lower risk of incident MACE (HR 0.76; 95% CI 0.62-0.94 per 1-SD increase) and cardiovascular readmissions over 3 years.
Why the study?
The association of circulating omega-3 fatty acids at the time of STEMI with long-term adverse cardiovascular events and mortality was not well established.
Are higher serum levels of EPA and ALA at the time of STEMI associated with a lower risk of MACE, all-cause mortality, and cardiovascular readmission in patients undergoing primary PCI?
Cohort (n=944)
Are higher serum levels of EPA and ALA at the time of STEMI associated with a lower risk of MACE, all-cause mortality, and cardiovascular readmission in patients undergoing primary PCI?
Hazard Ratio: 0.76 (95% CI 0.62–0.94)
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“if I was a clinician reading this paper, my take-home message would be that I should recommend eating food rich in omega-3 fatty acids, both marine and vegetable fatty acids, in STEMI patients to reduce adverse events during follow-up.”
“Heart attacks are still very common, and aside from treatments to keep the patient alive, researchers have been exploring approaches to secure the quality of life of the patient after the heart attack. What is novel about this research is that it shows that ALA and EPA appear to be partners in improving the long-term outcomes of heart attack sufferers. Consuming both marine and plant-based omega-3s, from foods like salmon, walnuts, and flaxseed, seems to offer the greatest protection.”
“Incorporating marine and vegetable omega-3s into the diet of patients at risk of cardiovascular disease is an integrative strategy for improving both their quality of life and prognosis if they suffer a heart attack.”
Higher circulating levels of marine and vegetable omega-3 fatty acids at the time of STEMI are associated with a reduced long-term risk of adverse clinical outcomes, including MACE and mortality.
BACKGROUND: Dietary omega-3 eicosapentaenoic acid (EPA) has multiple cardioprotective properties. The proportion of EPA in serum phosphatidylcholine (PC) mirrors dietary EPA intake during previous weeks. Circulating EPA in ST-segment elevation myocardial infarction (STEMI) relates to smaller infarct size and preserved long-term ventricular function. OBJECTIVES: The authors investigated whether serum-PC EPA (proxy for marine omega-3 consumption) levels at the time of STEMI were associated with a lower incidence of major adverse cardiovascular events (MACE), all-cause mortality, and readmission for cardiovascular (CV) causes at 3 years' follow-up. We also explored the association of alpha-linolenic acid (ALA, proxy for vegetable omega-3 intake) with all-cause mortality and MACE. METHODS: The authors prospectively included 944 consecutive patients with STEMI (mean age 61 years, 209 women) undergoing primary percutaneous coronary intervention. We determined serum-PC fatty acids with gas chromatography. RESULTS: During follow-up, 211 patients had MACE, 108 died, and 130 were readmitted for CV causes. A Cox proportional hazards model adjusted for known clinical predictors showed that serum-PC EPA at the time of STEMI was inversely associated with both incident MACE and CV readmission (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.62 to 0.94, and HR: 0.74; 95% CI: 0.58 to 0.95, respectively, for a 1-standard deviation [SD] increase). Serum-PC ALA was inversely related to all-cause mortality (HR: 0.65; 95% CI: 0.44 to 0.96, for a 1-SD increase). CONCLUSIONS: Elevated serum-PC EPA and ALA levels at the time of STEMI were associated with a lower risk of clinical adverse events. Consumption of foods rich in these fatty acids might improve the prognosis of STEMI.
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Lázaro et al. (2020) conducted a cohort in Acute Myocardial Infarction (STEMI) (n=944). Serum phosphatidylcholine eicosapentaenoic acid (EPA) and alpha-linolenic acid (ALA) levels vs. Lower levels (evaluated continuously per 1-SD increase) was evaluated on Major adverse cardiovascular events (MACE) (HR 0.76, 95% CI 0.62-0.94). Elevated serum-PC EPA at the time of STEMI was associated with a lower risk of incident MACE (HR 0.76; 95% CI 0.62-0.94 per 1-SD increase) and cardiovascular readmissions over 3 years.
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