Circulating eicosapentaenoic acid to oleic acid ratio and risk for cardiovascular events in patients with coronary artery disease: A sub-analysis of the SHINANO registry

Background

The omega-3/omega-6 polyunsaturated fatty acid (PUFA) ratio, particularly the eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio, is associated with cardiovascular disease. However, the clinical impact of omega-9 monounsaturated fatty acids (MUFAs) on cardiovascular disease is not well understood. In this study, we evaluated whether the PUFA/MUFA ratio, especially the EPA/oleic acid (OA) ratio, predicted clinical outcomes in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI).

Methods

The SHINANO registry was a prospective, observational, multicenter cohort study that enrolled 1923 consecutive patients with CAD. From this registry, we identified 182 patients for whom fatty acids were measured on admission and stratified them according to the median EPA/OA ratio. The primary endpoint was major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal myocardial infarction, ischemic stroke, heart failure, and PCI for a de novo lesion within 1 year.

Results

Patients' mean age was 72 ± 9 years, 24% were women, and 28% had acute coronary syndrome. The 1-year follow-up was completed in 181 patients (99.5%). There were 59 cases of MACE. In the Kaplan–Meier analysis, the MACE incidence was significantly higher in patients with an EPA/OA ratio of ≤ 0.1169 than in those with a ratio of ≥ 0.1170 (39.6% vs. 25.3%, p = 0.041). In a multivariate Cox regression analysis, an EPA/OA ratio ≥ 0.1170 was associated with a lower incidence of MACE (hazard ratio, 0.53; 95% confidence interval, 0.31–0.91; p = 0.020).

Conclusions

We demonstrated that the EPA/OA ratio predicted MACE in patients with CAD who underwent PCI.