Circulating Omega-6, But Not Omega-3 Polyunsaturated Fatty Acids, Are Associated with Clinical Outcomes in Patients with Acute Decompensated Heart Failure.

Toshiyuki Nagai,Michikazu Nakai,Teruo Noguchi,Hisao Ogawa,Yasuyuki Honda,Naotsugu Iwakami,Kengo Kusano,Takeshi Aiba,Toshihisa Anzai,Satoshi Honda,Kunihiro Nishimura,Yasuhide Asaumi,Satoshi Yasuda,Yasuo Sugano,Atsushi Okada

doi:10.1371/journal.pone.0165841

Abstract

BackgroundCirculating polyunsaturated fatty acid (PUFA) levels are associated with clinical outcomes in cardiovascular diseases including coronary artery disease and chronic heart failure (HF). However, their clinical implications in acute decompensated HF (ADHF) remain unclear. The aim of this study was to investigate the clinical roles of circulating PUFAs in patients with ADHF.MethodsCirculating levels of PUFAs, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA) and dihomo-gamma linoleic acid (DGLA), were measured on admission in 685 consecutive ADHF patients. Adverse events were defined as all-cause death and worsening HF.ResultsDuring a median follow-up period of 560 days, 262 (38.2%) patients had adverse events. Although patients with adverse events had lower n-6 PUFA (AA + DGLA) level than those without, n-3 PUFA (EPA + DHA) level was comparable between the groups. Kaplan-Meier analyses showed that lower n-6 PUFA level on admission was significantly associated with the composite of all-cause death and worsening HF, all-cause death, cardiovascular death and worsening HF (p < 0.001, p = 0.005, p = 0.021, p = 0.019, respectively). In a multivariate Cox model, lower n-6 PUFA level was independently associated with increased risk of adverse events (HR 0.996, 95% CI: 0.993–0.999, p = 0.027).ConclusionsLower n-6 but not n-3 PUFA level on admission was significantly related to worse clinical outcomes in ADHF patients. Measurement of circulating n-6 PUFA levels on admission might provide information for identifying high risk ADHF patients.

Highlights

Heart failure (HF) is a common and growing public health problem worldwide
Patients with adverse events had lower n-6 polyunsaturated fatty acid (PUFA) (AA + dihomo-gamma linoleic acid (DGLA)) level than those without, n-3 PUFA (EPA + docosahexaenoic acid (DHA)) level was comparable between the groups
In a multivariate Cox model, lower n-6 PUFA level was independently associated with increased risk of adverse events (HR 0.996, 95% confidence interval (CI): 0.993–0.999, p = 0.027)

Summary

Introduction

Heart failure (HF) is a common and growing public health problem worldwide. pharmacologic and non-pharmacologic therapies have been developed for patients with HF, mortality and morbidity remain significantly high [1, 2]. Despite conflicting evidence [16, 17], several clinical trials have demonstrated the cardioprotective effects of n-3 PUFAs to reduce cardiovascular events, including sudden cardiac death and acute myocardial infarction (AMI), in primary and secondary prevention settings of CVD [18, 19]. Circulating polyunsaturated fatty acid (PUFA) levels are associated with clinical outcomes in cardiovascular diseases including coronary artery disease and chronic heart failure (HF). Their clinical implications in acute decompensated HF (ADHF) remain unclear. The aim of this study was to investigate the clinical roles of circulating PUFAs in patients with ADHF.

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Results

Conclusion