Abstract
BackgroundA beneficial effect of a high n-3 long-chain polyunsaturated fatty acid (LCPUFA) intake has been observed in heart failure patients, who are frequently insulin resistant. We investigated the potential influence of impaired glucose metabolism on the relation between dietary intake of n-3 LCPUFAs and risk of acute myocardial infarction (AMI) in patients with coronary artery disease.MethodsThis prospective cohort study was based on the Western Norway B-Vitamin Intervention Trial and included 2,378 patients with coronary artery disease with available baseline glycosylated hemoglobin (HbA1c) and dietary data. Patients were sub-grouped as having no diabetes (HbA1c <5.7%), pre-diabetes (HbA1c ≥5.7%), or diabetes (previous diabetes, fasting baseline serum glucose ≥7.0, or non-fasting glucose ≥11.1 mmol/L). AMI risk was evaluated by Cox regression (age and sex adjusted), comparing the upper versus lower tertile of daily dietary n-3 LCPUFA intake.ResultsThe participants (80% males) had a mean age of 62 and follow-up of 4.8 years. A high n-3 LCPUFA intake was associated with reduced risk of AMI (hazard ratio 0.38, 95%CI 0.18, 0.80) in diabetes patients (median HbA1c = 7.2%), whereas no association was observed in pre-diabetes patients. In patients without diabetes a high intake tended to be associated with an increased risk (hazard ratio1.45, 95%CI 0.84, 2.53), which was significant for fatal AMI (hazard ratio 4.79, 95%CI 1.05, 21.90) and associated with lower HbA1c (mean ± standard deviation 4.55 ±0.68 versus 4.92 ±0.60, P = 0.02). No such differences in HbA1c were observed in those with pre-diabetes or diabetes.ConclusionsA high intake of n-3 LCPUFAs was associated with a reduced risk of AMI, independent of HbA1c, in diabetic patients, but with an increased risk of fatal AMI and lower HbA1c among patients without impaired glucose metabolism. Further studies should investigate whether patients with diabetes may benefit from having a high intake of n-3 LCPUFAs and whether patients with normal glucose tolerance should be careful with a very high intake of these fatty acids.Trial registrationThis trial is registered at clinicaltrials.gov as NCT00354081.
Highlights
A beneficial effect of a high n-3 long-chain polyunsaturated fatty acid (LCPUFA) intake has been observed in heart failure patients, who are frequently insulin resistant
A previous myocardial infarction was reported in 41.3%, percutaneous coronary intervention (PCI) in 21.5%, and coronary artery bypass graft surgery (CABG) in 14.0% of the patients
Data are scarce on the association between dietary intake of n-3 LCPUFA and acute myocardial infarction (AMI) in statin-treated patients with coronary artery disease (CAD), since most previous studies have based their results on circulating n-3 LCPUFAs and many investigations have been performed in groups that did not receive statins
Summary
A beneficial effect of a high n-3 long-chain polyunsaturated fatty acid (LCPUFA) intake has been observed in heart failure patients, who are frequently insulin resistant. We investigated the potential influence of impaired glucose metabolism on the relation between dietary intake of n-3 LCPUFAs and risk of acute myocardial infarction (AMI) in patients with coronary artery disease. Two recent meta-analyses of randomized controlled trials, investigating n-3 LCPUFA intake through diet or supplements, failed to demonstrate an overall preventive effect on cardiovascular events [4,5]. A recent large randomized controlled trial among patients at high cardiovascular risk showed no reduction in heart disease or cardiac death after treatment with 1 g/day of n-3 LCPUFA [6]. The overall intensive glucose lowering in ORIGIN may have influenced the negative results regarding n-3 LCPUFA supplements
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