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Abstract 4141774: Plasma omega-3 fatty acids/omega-6 fatty acids and arterial stiffness in middle aged healthy Japanese cohort
Circulation, Volume 150, Issue Suppl_1, Page A4141774-A4141774, November 12, 2024. Background:Numerous studies evaluating the effects of consumption of omega-3 fatty acids (ω3FAs) and omega-6 fatty acids (ω6FAs) on the prevention of cardiovascular disease (CVD) have yielded inconsistent results. In addition, the association between ω3FAs/ω6FAs and CVD has been suggested to vary with the daily intake levels of fatty acids among individuals. On the other hand, the longitudinal associations between plasma ω3FAs/ω6FAs and arterial stiffness, which is a predictor of CVD, have not been well elucidated.Hypothesis:We hypothesized that plasma ω3FAs are associated with the suppression of age-related increases in arterial stiffness, whereas plasma ω6FAs are associated with an increase in arterial stiffness.Aims:The objective of this study is to fill the existing research gap by investigating the longitudinal association between plasma ω3FAs/ω6FAs and arterial stiffness in a Japanese people, known for their higher intake of marine products.Methods:This prospective observational study included 2520 healthy Japanese participants (mean age:43.1±8.7y, men:83.1%) who underwent repeated annual health check-ups from 2008 to 2013. Participants with a history of CVD or treatment for CVD risk factors were excluded. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV), and plasma ω3FAs [docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)]/ω6FAs [arachidonic acid (AA), dihomo-gamma-linolenic acid (DGLA)] were evaluated by gas chromatography. The longitudinal association between plasma ω3FAs/ω6FAs and baPWV was evaluated by a linear mixed model adjusted for conventional CVD risk factors.Results:During a median follow-up of 5 years (IQR 4-5 years), 11034 baPWV measurements were performed. The linear mix model adjusted for conventional CVD risk factors revealed that both higher plasma AA and DGLA levels were significantly associated with an increase in baPWV (1SD increase in AA; β=12±3, 1SD increase in DGLA; β=14±3, both P
Abstract 4138953: Salivary Tumor Necrosis Factor-Alpha, Plasma Omega-3 Fatty Acid Index and Coronary Artery Plaque
Circulation, Volume 150, Issue Suppl_1, Page A4138953-A4138953, November 12, 2024. Background:Oral inflammation is thought to affect systemic atherosclerosis, but the mechanisms are unclear. Tumor necrosis factor-alpha (TNF-α) is an inflammatory cytokine that has been implicated in coronary plaque rupture as well as periodontitis by mediating periodontal destruction and inflammation. Blood levels of the omega-3 fatty acids have been inversely associated with systemic inflammation and coronary plaque volume, but their impact on oral inflammation requires further study.Objective:To examine the relationship between salivary levels of TNF-α, plasma levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and coronary plaque.Methods:Salivary TNF-α was measured in gingival crevicular fluid in 199 patients with clinical coronary artery disease on statin therapy. Fatty, fibrous and noncalcified coronary plaque volumes were measured using coronary CT angiography. The plasma omega-3 fatty acid index was the sum of EPA and DHA of total plasma fatty acids. Linear regression estimated the association between TNF-α, omega-3 fatty acid index and coronary plaque volumes.Results:Mean age was 62.7±7.5 years; mean LDL-C was 78.2±28.9 mg/dL, and median triglyceride was 119 [80.5,165.0] mg/dL. Higher salivary TNF-α was independently associated with a lower plasma omega-3 fatty acid index (Table 1). Moreover, higher salivary TNF-α was independently associated with higher fatty, fibrous, and noncalcified plaque volumes after adjustment for age, sex, BMI, triglyceride, LDL-C, diabetes status, diastolic blood pressure, albumin-to-creatinine ratio, and estimated glomerular filtration rate (Table 2).Conclusions:The inverse relationship between salivary TNF-α and the plasma omega-3 fatty acid index and direct relationship with fatty plaque suggests that maintaining high blood levels of omega-3 fatty acids may be beneficial in lowering oral inflammation and amount of fatty plaque, thus, potentially decreasing risk for acute coronary syndromes.
Abstract 4140072: Icosapent Ethyl-Associated New Atrial Fibrillation Incidence compared to Omega-3 Fatty Acids: An Observational Cohort Study
Circulation, Volume 150, Issue Suppl_1, Page A4140072-A4140072, November 12, 2024. Introduction:Icosapent ethyl (IE), an ethyl ester derivative of eicosapentanoic acid (EPA), and omega-3 acid ethyl esters, an ethyl ester derivative of both EPA and docosahexaenoic acid (DHA), are approved as adjunct to statin therapy for reducing MACE in patients with elevated triglyceride levels. There are concerns regarding atrial fibrillation (AF) risk associated with IE. This study aims to assess the incidence of AF while receiving IE versus omega-3-acid ethyl esters (DHA/EPA), both alongside baseline statin therapy.Methods:In this retrospective cohort study, we used data from the Merative MarketScan Commercial Claims and Medicare Supplemental Databases (2013-2021). Adult patients on statin therapy who initiated either IE or DHA/EPA were identified using outpatient dispensing records. Patients with an AF diagnosis during the one-year baseline period were excluded. Patients were followed for up to two years to assess the incidence of AF. Censoring occurred if there was treatment discontinuation, switching between treatments, end of enrollment, or end of the study. Patients experiencing events or being censored within the first 30 days were also excluded. Propensity score matching was used to create comparable groups, with exact matching on time periods (2013-2015, 2016-2018, and 2019-2021). Using Cox proportional hazard regression model, we calculated hazards ratio of the onset of AF for IE versus DHA/EPA.Results:The analytic cohort consisted of 17,638 matched pairs. Patients in both groups had a median age of 56 years. Male patients accounted for a 65.7% of the IE group and 64.5% of the DHA/EPA group. Baseline cardiovascular risk factors were well matched between both groups. The 2-year cumulative incidence of AF for IE and DHA/EPA groups were 5.322% and 3.994%, respectively, resulting in a HR of 1.257 [95% CI,1.159-1.364], p=0.0032. (Figure 1)Conclusions:IE is associated with a higher risk of AF compared to DHA/EPA combined products, indicating the need for careful risk-benefit discussion between clinicians and patients considering IE therapy.
Abstract 4119941: Identification of individuals who benefit from omega-3 fatty acid supplementation to prevent coronary heart disease: A machine-learning analysis of the VITAL
Circulation, Volume 150, Issue Suppl_1, Page A4119941-A4119941, November 12, 2024. Backgrounds:Randomized controlled trials (RCTs) have demonstrated benefits of marine omega-3 polyunsaturated fatty acids (omega-3 FA) supplementation for the prevention of coronary heart disease (CHD). However, it has not been clear which individuals would benefit the most from the supplementation. We sought to predict the individual treatment effect of omega-3 FA supplementation on CHD prevention and to develop an omega-3 effect score to stratify individuals according to their expected benefit from the supplementation.Methods:Among the 25,871 randomized participants without history of CVD in the VITamin D and OmegA-3 TriaL (VITAL), we applied machine-learning (ML) approaches to predict individual treatment effect of omega-3 FA supplementation on 5-year CHD risk (a composite of myocardial infarction, coronary revascularization, and CHD death) using 11 covariates pre-specified in the VITAL trial protocol. A 10-fold cross-validation was used and held-out test dataset was used for the evaluation. An omega-3 effect score was developed such that each covariate contributed linearly, and utility of the score was further evaluated by transportability analysis using the National Health and Nutrition Examination Survey (NHANES) data as the target population.Results:Omega-3 FA intervention led to absolute 0.48% [SE: 0.20] reduction in CHD in the total population. ML algorithms effectively stratified participants by their expected benefit according to individual factors; decreased CHD risk was observed in those with quintile 1 and 2 of the expected benefit (absolute CHD risk reduction %: 1.30 % [0.55] and 1.32 % [0.51] in quintile 1 and 2, respectively). Race, diabetes, and fish intake most contributed to the omega-3 effect score. CHD incidence rates per 1000 person-year were 5.5 [0.44] if treated and 8.5 [0.55] if not treated (35.3% reduction) in individuals with the score ≥11 (upper 40th percentile), and 3.9% [0.31] if treated and 3.4% [0.55] if not treated (14.7% increase) in those with the score
Abstract 4147395: Peanut Induced Myositis: The Adversity from Overconsumption of Omega 6 Fatty Acids
Circulation, Volume 150, Issue Suppl_1, Page A4147395-A4147395, November 12, 2024. Background:Peanuts, a heart-healthy staple due to their high polyphenolic antioxidant content, contain a substantial amnount of omega 6 fatty acids. An excess of the Omega-6 polyunsaturated fatty acids (PUFAs), up regulates the body’s inflammatory pathways.The n-6 PUFA-derived lipid mediators trigger inflammation, platelet aggregation, and vasoconstriction. Omega 3 fatty acids in foods such as salmon or avocado, inhibit inflammation and platelet aggregation while enhancing vasodilation. Over consumption of omega 6 fatty acids by more than the 5-10% daily recommendation can lead to inflammatory conditions like myositis, as seen in this case presentation.Case Presentation:A 70-year-old Caucasian male presented to his primary care clinic for worsening bilateral lower extremity myalgias for the past few months. His medical history includes hypertension, non-insulin- dependent type 2 diabetes, and hyperlipidemia. He denied any trauma, strenuous exercise, myocardial infarction, or mechanical falls. His home medications were aspirin, low-dose Crestor, Pioglitazone, Janumet, and Farxiga. Radiographic imaging of the lower extremities was unremarkable. He had elevated creatinine kinase (CK) levels from 2018-2022, ranging from 300-500’s. A trial withholding the statin (Crestor), was initiated to check for improvement, but serum creatinine levels remained high. His muscle biopsy was unrevealing as well. During an office visit in 2022, the patient incidentally stated he had been eating a one-pound bag of shelled peanuts daily for the lat 4 years to improve his health. He was advised to eliminate peanuts for a month and have a follow up CK level testing.Results:The creatinine kinase levels between 2018-2022 revealed a baseline elevation until May 2022 when the patient returned for an office visit after abstaining from peanuts for a month. His CK levels not only normalized in May 2022, but also coincided with resolution of his myalgias. These results reveal the association between over consumption of omega 6 fatty acids as a trigger for myositis.Conclusion:The patient was educated on the detrimental health effects from over consumption of omega 6 fatty acids and the importance of moderation in the diet. This case illustrates the link between omega-6 fatty acid as a precursor to inflammatory disease. The patient’s peanut consumption being the culprit of his myositis also highlights the importance of good history taking and exploring diet as a conduit to disease management.
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