The omega-3 fatty acid eicosapentaenoic acid (EPA) is inversely associated with ischemic brain infarcts in elderly patients with atrial fibrillation
One of the presentations today
Congress : ESC Congress 2019
SESSION Poster Session 4
SPEAKER Martin Franz Reiner
Congress : ESC Congress 2019
Topic : Aortic Disease, Peripheral Vascular Disease, Stroke
Sub-topic : Stroke - Prevention
Session type : Poster Session
FP Number : P3712
Authors : MF Reiner (Zurich,CH), P Baumgartner (Baden,CH), A Wiencierz (Basel,CH), S Aeschbacher (Basel,CH), N Rodondi (Bern,CH), O Baretella (Bern,CH), M Kuehne (Basel,CH), G Moschovitis (Lugano,CH), LH Bonati (Basel,CH), C Von Schacky (Munich,DE), TF Luescher (London,GB), GG Camici (Zurich,CH), S Osswald (Basel,CH), D Conen (Ontario,CA), JH Beer (Baden,CH)
Abstract
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Abstract
Authors:
MF Reiner1 , P Baumgartner2 , A Wiencierz3 , S Aeschbacher4 , N Rodondi5 , O Baretella6 , M Kuehne4 , G Moschovitis7 , LH Bonati8 , C Von Schacky9 , TF Luescher10 , GG Camici11 , S Osswald4 , D Conen12 , JH Beer2 , 1University Hospital Zurich - Zurich - Switzerland , 2Cantonal Hospital of Baden, Internal Medicine - Baden - Switzerland , 3University Hospital Basel, Clinical Trial Unit - Basel - Switzerland , 4University Hospital Basel, Department of Cardiology - Basel - Switzerland , 5Bern University Hospital, Internal Medicine - Bern - Switzerland , 6Bern University Hospital, Institute of Primary Health Care - Bern - Switzerland , 7Lugano Regional Hospital, Division of Cardiology - Lugano - Switzerland , 8University Hospital Basel, Department of Neurology and Stroke - Basel - Switzerland , 9Ludwig-Maximilians University, Department of Preventive Cardiology - Munich - Germany , 10Imperial College London - London - United Kingdom of Great Britain & Northern Ireland , 11University of Zurich, Center for Molecular Cardiology - Zurich - Switzerland , 12Mcmaster University - Ontario - Canada ,
Citation:
Background
The association of individual omega-3 fatty acids (n-3 FAs) with ischemic stroke remains unclear. Experimental data strongly suggest that n-3 FAs reduce ischemic stroke due to their anti-thrombotic and anti-inflammatory properties. Yet, recent clinical trials yielded mixed results. While marine n-3 FA supplementation (1g/day) did not reduce stroke, icosapent ethyl, a purified eicosapentaenoic acid (EPA) ethyl ester (4g/day), significantly reduced stroke incidence in patients at high cardiovascular risk. In the current study, we examined the association of fish-derived EPA, docosapentaenoic acid (DPA), docosahexaenoic acid (DHA) and the plant-derived alpha-linolenic acid (ALA) with the prevalence of ischemic brain infarcts in elderly patients with atrial fibrillation.
Methods
In this cross-sectional analysis of the Swiss atrial fibrillation (swissAF) cohort study, we determined baseline whole blood n-3 FAs by gas chromatography according to the HS-Omega-3 Index methodology in 1665 patients aged = 65 years with atrial fibrillation. Large non-cortical and cortical infarcts (LNCCI) were assessed by brain MRI. Total and individual n-3 FAs were correlated with the prevalence of LNCCI in a logit model with continuous factors. Analyses were adjusted for sex, age, body mass index, smoking, alcohol intake, family history of cardiovascular disease and atrial fibrillation, physical activity, hypertension, diabetes, chronic kidney disease, prior stroke, prior transient ischemic attack, aspirin, anticoagulation and type of atrial fibrillation.
Results
A total of 373 patients with LNCCI (22.4%) were identified. After adjustment, lower risk of LNCCI was associated with higher EPA (odds ratio [OR] 0.50 per increase of one percentage point EPA, 95% confidence interval [CI] 0.28 – 0.88) and a higher risk was detected with DPA (OR 2.39, 95% CI 1.43 – 4.01). No statistically significant association was detected with DHA (OR 1.13, 95% CI 0.94 – 1.35), ALA (OR 0.83, 95% CI 0.23 – 2.95) or total n-3 FAs (OR 1.03, 95% CI 0.92 – 1.16).
Conclusions
Higher levels of EPA are associated with a lower prevalence of ischemic infarcts in aged patients with atrial fibrillation. Unexpectedly, DPA shows a direct correlation with ischemic infarcts. This study demonstrates that individual n-3 FAs may differentially affect stroke risk and that supplementation of EPA may be an interesting strategy to prevent ischemic stroke in atrial fibrillation patients.
