Eicosapentaenoic acid confers cardioprotection in heart failure
An increased abundance of eicosapentaenoic acid (EPA) is associated with a reduced risk of heart failure (HF), and this protective effect is independent of established risk factors and ejection fraction status, according to a study presented at the American Heart Association (AHA) Scientific Sessions 2018 in Chicago, Illinois, US.
“Given HF is a leading cause of hospitalization and death in the US and globally, and there are currently no effective treatments for HF with preserved ejection fraction (HFpEF), these findings have important clinical implications,” the authors said.
The study included 6,566 adult participants (52 percent female; 38.55 percent Caucasian) from the Multi-Ethnic Study of Atherosclerosis study who had available baseline EPA data. HF occurred in 293 individuals over a median follow-up of 13.0 years, among whom 129 had HF with reduced ejection fraction, 110 had HFpEF and the remaining 54 had unknown ejection fraction status. [AHA 2018, abstract 026]
Compared with HF-free controls, participants who developed HF had significantly lower mean plasma phospholipid EPA levels (0.70 percent vs 0.77 percent; p=0.002).
Cox proportional hazards analysis revealed that increased EPA levels were associated with a lower incidence of HF (hazard ratio [HR] per unit change in percentage of total fatty acids, 0.73; 95 percent CI, 0.60–0.89; p=0.001).
The association persisted despite adjusting for age, sex, race, body mass index, smoking, diabetes mellitus, blood pressure, lipids and lipid-lowering drugs, and albuminuria. Sensitivity analysis showed no dependence on HF type, and controlling for other fatty acids with clustering did not change the risk estimates.
“We have previously demonstrated in a mouse model of pressure overload-induced HF that EPA preserves contractile function and prevents interstitial myocardial fibrosis,” the authors said.
The present data confirm that EPA is similarly protective in humans, they added.
In animals, EPA level of >2.5 percent is required for prevention of HF, between 2.5 percent and 1 percent is marginal, and <1 percent is insufficient. In the present study, most participants (n=4,794) had insufficient EPA levels, fewer (n=1,471) had marginal levels and fewer still (n=301) had sufficient levels.
“[Individuals] with sufficient EPA levels were at 0.40-fold (0.15–0.81) risk compared to [those with] insufficient EPA (p=0.008),” the authors noted.