Importance of fatty acid compositions in patients with peripheral arterial disease.

Milan Gautam,Takahiro Takeuchi,Yuji Shiba,Atsushi Izawa,Jun Koyama,Uichi Ikeda,Yusuke Miyashita,Hirohiko Motoki,Takeshi Tomita,Ayako Okada,Yan Gong

doi:10.1371/journal.pone.0107003

Abstract

ObjectiveImportance of fatty acid components and imbalances has emerged in coronary heart disease. In this study, we analyzed fatty acids and ankle-brachial index (ABI) in a Japanese cohort.MethodsPeripheral arterial disease (PAD) was diagnosed in 101 patients by ABI ≤0.90 and/or by angiography. Traditional cardiovascular risk factors and components of serum fatty acids were examined in all patients (mean age 73.2±0.9 years; 81 males), and compared with those in 373 age- and sex-matched control subjects with no evidence of PAD.ResultsThe presence of PAD (mean ABI: 0.71±0.02) was independently associated with low levels of gamma-linolenic acid (GLA) (OR: 0.90; 95% CI: 0.85–0.96; P = 0.002), eicosapentaenoic acid∶arachidonic acid (EPA∶AA) ratio (OR: 0.38; 95% CI: 0.17–0.86; P = 0.021), and estimated glomerular filtration rate (OR: 0.97; 95% CI: 0.96–0.98; P<0.0001), and with a high hemoglobin A1c level (OR: 1.34; 95% CI: 1.06–1.69; P = 0.013). Individuals with lower levels of GLA (≤7.95 µg/mL) and a lower EPA∶AA ratio (≤0.55) had the lowest ABI (0.96±0.02, N = 90), while the highest ABI (1.12±0.01, N = 78) was observed in individuals with higher values of both GLA and EPA∶AA ratio (P<0.0001).ConclusionA low level of GLA and a low EPA∶AA ratio are independently associated with the presence of PAD. Specific fatty acid abnormalities and imbalances could lead to new strategies for risk stratification and prevention in PAD patients.

Highlights

Peripheral arterial disease (PAD) is a manifestation of advanced systemic atherosclerosis, and is associated with high mortality and morbidity from cardiovascular disease (CVD) [1], [2]
The presence of PAD was independently associated with low levels of gamma-linolenic acid (GLA) (OR: 0.90; 95% confidence interval. *Adjusted for age (CI): 0.85–0.96; P = 0.002), eicosapentaenoic acid:arachidonic acid (EPA:AA) ratio (OR: 0.38; 95% CI: 0.17– 0.86; P = 0.021), and estimated glomerular filtration rate (OR: 0.97; 95% CI: 0.96–0.98; P,0.0001), and with a high hemoglobin A1c level (OR: 1.34; 95% CI: 1.06–1.69; P = 0.013)
A low level of GLA and a low EPA:AA ratio are independently associated with the presence of PAD

Summary

Introduction

Peripheral arterial disease (PAD) is a manifestation of advanced systemic atherosclerosis, and is associated with high mortality and morbidity from cardiovascular disease (CVD) [1], [2]. The prevalence of PAD in Japanese aged $40 years is lower, ranging from 1.5% to 2.7% [4], [5], [6], the number of Japanese PAD patients is anticipated to increase in the near future Traditional risk factors, such as diabetes mellitus (DM), hypertension, current smoking, and dyslipidemia, are strongly associated with the risk of PAD [3], [7]. The average body mass index of our PAD patients was 5% lower than that of controls This suggested the obesity paradox, which has been explained in part by malnutrition and/or systemic inflammation due to the severity of PAD and, more importantly, is associated with the high mortality of PAD patients [28], [29]. Additive administration of EPA to increase the EPA:AA ratio has reduced the incidence of secondary major adverse cardiovascular events in patients with either PAD [38] or established coronary artery disease [18]

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Results

Conclusion