Association between the ratio of serum n-3 to n-6 polyunsaturated fatty acids and acute coronary syndrome in non-obese patients with coronary risk factor: a multicenter cross-sectional study

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Abstract

Background

Previous studies have reported that being overweight, obese, or underweight is a risk factor for ischemic cardiovascular disease (CVD); however, CVD also occurs in subjects with ideal body mass index (BMI). Recently, the balance of n-3/n-6 polyunsaturated fatty acids (PUFAs) has received attention as a risk marker for CVD but, so far, no study has been conducted that investigates the association between BMI and the balance of n-3/n-6 PUFAs for CVD risk.

Methods

We evaluated the association between n-3/n-6 PUFA ratio and acute coronary syndrome (ACS) in three BMI-based groups (< 25: low BMI, 25–27.5: moderate BMI, and ≥ 27.5: high BMI) that included 1666 patients who visited the cardiovascular medicine departments of five hospitals located in urban areas in Japan.

Results

The prevalence of ACS events was 9.2, 7.3, and 10.3% in the low, moderate, and high BMI groups, respectively. We analyzed the relationship between ACS events and several factors, including docosahexaenoic acid/arachidonic acid (DHA/AA) ratio by multivariate logistic analyses. In the low BMI group, a history of smoking (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.40–4.35) and low DHA/AA ratio (OR: 0.30, 95% CI: 0.12–0.74) strongly predicted ACS. These associations were also present in the moderate BMI group but the magnitude of the association was much weaker (ORs are 1.47 [95% CI: 0.54–4.01] for smoking and 0.63 [95% CI: 0.13–3.10] for DHA/AA). In the high BMI group, the association of DHA/AA (OR: 1.98, 95% CI: 0.48–8.24) was reversed and only high HbA1c (OR: 1.46, 95% CI: 1.03–2.08) strongly predicted ACS. The interaction test for OR estimates (two degrees of freedom) showed moderate evidence for reverse DHA/AA ratio–ACS associations among the BMI groups ( P = 0.091).

Conclusions

DHA/AA ratio may be a useful marker for risk stratification of ACS, especially in non-obese patients.

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Most cited references 19

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For this report, we examined the relationships between the conditions of being overweight and obese and mortality from all causes, heart disease, cardiovascular disease, and cancer. We defined the categories of body weight according to level of body mass index, BMI=wt(kg)/ht(m)2, using classifications suggested by the National Institutes of Health and the World Health Organization. These classifications are as follows: "normal weight" is defined as BMI > or = 18.5, but less than 25; "overweight" equals BMI > or = 25, but less than 30; and "obese" individuals have BMIs > or = 30. Our investigation is based on person-level data from 26 observational studies that include both genders, several racial and ethnic groups, and samples from the US and other countries. The database consists of 74 analytic cohorts, arranged according to natural strata including gender, race, and area of residence. It includes 388,622 individuals, with 60,374 deaths during follow-up. We use proportional hazards models to examine the relationships between the BMI categories and mortality, controlling for age and smoking status. We use random-effects models to assess summary relative risks associated with the overweight and obesity conditions across cohorts. The relative risks among the heaviest individuals for overall death, death caused by coronary heart disease (CHD), and death caused by cardiovascular disease (CVD) are 1.22, 1.57, and 1.48, respectively, when compared with the those within the lowest BMI category. The summary relative risk among the heaviest participants for death from cancer is 1.07. We document once again, excess mortality associated with obesity. Our results do, however, question whether the current classification of individuals as "overweight" is optimal in the sense, since there is little evidence of increased risk of mortality in this group.

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Effect of fish oil on heart rate in humans: a meta-analysis of randomized controlled trials.

Johanna M. Geleijnse, Peter Zock, Dariush Mozaffarian … (2005)

The effect of fish oil on heart rate (HR), a major risk factor for sudden death, is not well established. We calculated this effect in a meta-analysis of randomized, double-blind, placebo-controlled trials in humans. Randomized trials of fish oil that evaluated HR were identified through MEDLINE (1966 through January 2005), hand-searching of references, and contact with investigators for unpublished results. Two investigators independently extracted trial data. A pooled estimate was calculated from random-effects meta-analysis. Predefined stratified meta-analyses and meta-regression were used to explore potential heterogeneity. Of 197 identified articles, 30 met inclusion criteria. Evidence for publication bias was not present. In the overall pooled estimate, fish oil decreased HR by 1.6 bpm (95% CI, 0.6 to 2.5; P=0.002) compared with placebo. Between-trial heterogeneity was evident (Q test, P or =69 bpm (median) but had little effect (0.04-bpm reduction; P=0.56) in trials with baseline HR or =12 weeks but had less effect (0.7-bpm reduction; P=0.27) in trials with duration 0.25 for each). In randomized controlled trials in humans, fish oil reduces HR, particularly in those with higher baseline HR or longer treatment duration. These findings provide firm evidence that fish oil consumption directly or indirectly affects cardiac electrophysiology in humans. Potential mechanisms such as effects on the sinus node, ventricular efficiency, or autonomic function deserve further investigation.

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Author and article information

Contributors

Yuji Nishizaki: ynishiza@juntendo.ac.jp

Journal

Journal ID (nlm-ta): BMC Cardiovasc Disord

Journal ID (iso-abbrev): BMC Cardiovasc Disord

Title: BMC Cardiovascular Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2261

Publication date (Electronic): 6 April 2020

Publication date PMC-release: 6 April 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 160

Affiliations

[1 ]GRID grid.258269.2, ISNI 0000 0004 1762 2738, Department of Cardiovascular Medicine, , Juntendo University Graduate School of Medicine, ; 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421 Japan

[2 ]GRID grid.258269.2, ISNI 0000 0004 1762 2738, Medical Technology Innovation Center, , Juntendo University, ; 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421 Japan

[3 ]GRID grid.412178.9, ISNI 0000 0004 0620 9665, Department of Cardiology, , Nihon University Hospital, ; 1-6 Kanda surugadai, Chiyoda-ku, Tokyo, 101-8309 Japan

[4 ]GRID grid.411898.d, ISNI 0000 0001 0661 2073, Divison of Cardiology, Department of Internal Medicine, , The Jikei University School of Medicine, ; 3-25-8, Nishi-Shimbashi Minato-ku, Tokyo, 105-8461 Japan

[5 ]GRID grid.26999.3d, ISNI 0000 0001 2151 536X, Department of Cardiovascular Medicine, Graduate School of Medicine, , The University of Tokyo, ; 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655 Japan

[6 ]GRID grid.410804.9, ISNI 0000000123090000, Division of Cardiovascular Medicine, Department of Medicine, , Jichi Medical University School of Medicine, ; 3311-1 Yakushiji Shimotsuke-shi, Tochigi-ken, 329-0498 Japan

[7 ]Department of Internal Medicine, Tokyo Takanawa Hospital, 3-10-11, Takanawa Minato-ku, Tokyo, 108-8606 Japan

[8 ]GRID grid.143643.7, ISNI 0000 0001 0660 6861, Department of Information and Computer Technology, Faculty of Engineering, , Tokyo University of Science, ; 6-3-1 Niijuku, Katsushika-ku, Tokyo, 125-8585 Japan

[9 ]GRID grid.260969.2, ISNI 0000 0001 2149 8846, Division of Cardiology, Department of Medicine, , Nihon University School of Medicine, ; 30-1 Ohyaguchi Kamichou Itabashi-ku, Tokyo, 173-8610 Japan

[10 ]GRID grid.410804.9, ISNI 0000000123090000, Jichi Medical University, ; 3311-1 Yakushiji Shimotsuke-shi, Tochigi-ken, 329-0498 Japan

[11 ]GRID grid.258269.2, ISNI 0000 0004 1762 2738, Faculty of Health Science, , Juntendo University, ; 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421 Japan

Article

Publisher ID: 1445

DOI: 10.1186/s12872-020-01445-w

PMC ID: 7137439

PubMed ID: 32252654

SO-VID: 0db1cb42-1595-49a7-9692-0e08ad193b22

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 12 November 2019

Date accepted : 24 March 2020

Funding

Funded by: MEXT - Ministry of Education, Culture, Sports, Science and Technology (JP)

Custom metadata

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: acute coronary syndrome,arachidonic acid,body mass index,docosahexaenoic acid,eicosapentaenoic acid,docosahexaenoic acid/arachidonic acid ratio,eicosapentaenoic acid/arachidonic acid ratio,polyunsaturated fatty acids (pufas)

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: acute coronary syndrome, arachidonic acid, body mass index, docosahexaenoic acid, eicosapentaenoic acid, docosahexaenoic acid/arachidonic acid ratio, eicosapentaenoic acid/arachidonic acid ratio, polyunsaturated fatty acids (pufas)

Association between the ratio of serum n-3 to n-6 polyunsaturated fatty acids and acute coronary syndrome in non-obese patients with coronary risk factor: a multicenter cross-sectional study

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Abstract

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Cardiovascular Innovations and Applications

Most cited references 19

Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies.

Unstable angina. A classification.

Effect of fish oil on heart rate in humans: a meta-analysis of randomized controlled trials.

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