Abstract 10997: The Ratio of Eicosapentaenoic Acid to Arachidonic Acid is Associated with Lipid-Rich Coronary Plaque
Background: Epidemiological and clinical evidence suggests a significant inverse association between eicosapentaenoic acid (EPA) and mortality related to coronary artery disease.
Objectives: We hypothesized that EPA would be associated with the incidence of acute coronary syndrome (ACS) and assessed the impact of EPA and arachidonic acid (AA) on coronary plaque instability.
Methods and Results: A total of 402 consecutive patients who underwent coronary angiography were allocated to the presence or absence of ACS. 41 patients were excluded because of the EPA treatment at baseline. Various lipid and inflammatory profiles including EPA and AA were measured for 361 patients. Conventional and integrated backscatter intravascular ultrasound (IB-IVUS) parameters were measured in 36 patients with ACS and 82 patients without ACS. A personal computer (Windows XP Professional, CPU: 3.4 GHz) equipped with commercially available custom software (IB-IVUS, YD Co., Japan) was connected to the IVUS imaging system (Visiwave, Termo Co., Japan) in order to obtain radio frequency, and signal trigger outputs. Ultrasound backscattered signals were acquired using a 40 MHz (motorized pullback 0.5mm/s) mechanically rotating IVUS catheter. Lipid-rich plaques (LRP) were defined as plaques with greater lipid content (lipid volume>median and fibrous volume<median). The ratio of EPA to AA (EPA/AA ratio) was significantly lower in patients with ACS compared to those without (0.28 ± 0.19 vs. 0.47 ± 0.30, p<0.0001). On univariate logistic regression analysis for all subjects (n=361), EPA/AA ratio, the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (L/H ratio) and high sensitive C-reactive protein were significantly associated with the incidence of ACS. After adjustment of confounding and classical risk factors, only the EPA/AA ratio was significantly associated with the incidence of ACS (OR:0.66, 95%CI:0.54–0.82, p=0.0002). On IB-IVUS analysis (n=118), the EPA/AA ratio was the only predictor for LRP (OR:0.81, 95% CI:0.66–0.99, p=0.038) even after adjustment for confounders.
Conclusions: The ratio of EPA to AA was significantly and independently associated with LRP, suggesting the contribution to the incidence of ACS.
- © 2010 by American Heart Association, Inc.