Abstract 12444: Low Levels of Serum N-3 Polyunsaturated Fatty Acids are Associated with Worse Heart Failure Free Survival in Patients with Acute Myocardial Infarction

Abstract

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: We evaluated whether serum DHA and EPA levels were associated with a HF-free survival, and HF hospitalization rates in patients after AMI who registered to a multi-center prospective AMI registry in Japan. We enrolled 712 AMI patients and divided them into 3 groups (Low, Middle, and High) according to the tertile values of DHA or EPA serum levels. Event rates were compared using the Kaplan-Meier method and log-rank test. The impact of serum n-3 PUFA levels was assessed using propensity-score-stratified Cox regression analysis.

Results: Patients had a median age of 65 years old, 77.8% were male, 86.1% had ST-elevation myocardial infarction and 93.3% underwent percutaneous coronary intervention. The prescription rates at discharge of statin, angiotensin converting enzyme inhibitor and/or angiotensin receptor blocker, beta-blocker, and anti-platelet agents were 60.5%, 82.3%, 67.0% and 99.0%, respectively. There were 35 HF hospitalizations and 45 any cause death events at the median follow-up duration of 1079 days. Although both the DHA and EPA Low groups showed statistically significant worse HF-free survival as compared with other groups (log-rank p=0.0204 in DHA and 0.0353 in EPA), only the EPA Low group had a higher risk of HF hospitalization (HR 2.40, p=0.0097). The unfavorable impacts of low DHA or EPA levels were generally common in all subgroups; however, the impact of low serum EPA on HF hospitalization was particularly prominent in male patients, and those with low high-density lipoprotein cholesterol or without statin therapy.

Conclusions: In our study, low levels of serum n-3 PUFA are associated with worse HF-free survival in patients with AMI.