Watanabe Shunsuke, Yoshihisa Akiomi, Kanno Yuki, Takiguchi Mai, Yokokawa Tetsuro, Sato Akihiko, Miura Shunsuke, Shimizu Takeshi, Abe Satoshi, Sato Takamasa, Suzuki Satoshi, Oikawa Masayoshi, Sakamoto Nobuo, Yamaki Takayoshi, Sugimoto Koichi, Kunii Hiroyuki, Nakazato Kazuhiko, Suzuki Hitoshi, Saitoh Shu-Ichi, Takeishi Yasuchika
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan; Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan.
J Card Fail. 2016 Dec;22(12):962-969. doi: 10.1016/j.cardfail.2016.04.017. Epub 2016 Apr 29.
Intake of n-3 polyunsaturated fatty acids (n-3 PUFAs) lowers the risk of atherosclerotic cardiovascular events, particularly ischemic heart disease. In addition, the ratio of eicosapentaenoic acid (EPA; n-3 PUFA) to arachidonic acid (AA; n-6 PUFA) has recently been recognized as a risk marker of cardiovascular disease. In contrast, the prognostic impact of the EPA/AA ratio on patients with heart failure (HF) remains unclear.
A total of 577 consecutive patients admitted for HF were divided into 2 groups based on median of the EPA/AA ratio: low EPA/AA (EPA/AA <0.32 mg/dl, n = 291) and high EPA/AA (EPA/AA ≥0.32, n = 286) groups. We compared laboratory data and echocardiographic findings and followed cardiac mortality. Although body mass index, blood pressure, B-type natriuretic peptide, hemoglobin, estimated glomerular filtration rate, total protein, albumin, sodium, C-reactive protein, and left ventricular ejection fraction did not differ between the 2 groups, cardiac mortality was significantly higher in the low EPA/AA group than in the high EPA/AA group (12.7 vs 5.9%, log-rank P = .004). Multivariate Cox proportional hazard analysis revealed that the EPA/AA ratio was an independent predictor of cardiac mortality (hazard ratio 0.677, 95% confidence interval 0.453-0.983, P = .041) in patients with HF.
The EPA/AA ratio was an independent predictor of cardiac mortality in patients with HF; therefore, the prognosis of patients with HF may be improved by taking appropriate management to control the EPA/AA balance.
摄入n-3多不饱和脂肪酸（n-3 PUFAs）可降低动脉粥样硬化性心血管事件的风险，尤其是缺血性心脏病。此外，二十碳五烯酸（EPA；n-3 PUFA）与花生四烯酸（AA；n-6 PUFA）的比值最近被认为是心血管疾病的风险标志物。相比之下，EPA/AA比值对心力衰竭（HF）患者预后的影响仍不清楚。
共有577例因HF入院的连续患者根据EPA/AA比值的中位数分为两组：低EPA/AA组（EPA/AA<0.32mg/dl，n=291）和高EPA/AA组（EPA/AA≥0.32，n=286）。我们比较了实验室数据和超声心动图检查结果，并随访了心脏死亡率。虽然两组之间的体重指数、血压、B型利钠肽、血红蛋白、估计肾小球滤过率、总蛋白、白蛋白、钠、C反应蛋白和左心室射血分数没有差异，但低EPA/AA组的心脏死亡率显著高于高EPA/AA组（12.7%对5.9%，对数秩检验P=0.004）。多变量Cox比例风险分析显示，EPA/AA比值是HF患者心脏死亡率的独立预测因子（风险比0.677，95%置信区间0.453-0.983，P=0.041）。
EPA/AA比值是HF患者心脏死亡率的独立预测因子；因此，通过采取适当的管理措施来控制EPA/AA平衡，可能会改善HF患者的预后。
