Eicosapentaenoic-to-Arachidonic Acid Ratio Predicts Mortality and Recurrent Vascular Events in Ischemic Stroke Patients

Abstract

The ratio of eicosapentaenoic acid (EPA) to arachidonic acid (AA) is related to major adverse events and death in cardiovascular diseases. The association between long-term prognosis of ischemic stroke and EPA/AA ratio has not been clarified. Methods: Acute ischemic stroke patients who had undergone blood examinations for polyunsaturated fatty acids were enrolled. Major cardiovascular events, including recurrence of ischemic stroke, occurrence of cardiovascular and peripheral artery diseases and hemorrhagic stroke, and death, were analyzed, retrospectively. Cox proportional hazards regression analysis was used to explore factors, including clinical characteristics, laboratory data including EPA/AA ratio, and treatments associated with major cardiovascular events and death. Results: A total of 269 patients (mean age, 70 13 years; 179 men) were enrolled. During follow-up (mean, 2.3 1.0 years), 64 patients exhibited major cardiovascular events and death (annualized rate, 10.5% per personyear). Multivariate Cox analysis revealed that EPA/AA ratio (hazard ratio, 0.26; 95% confidence interval, 0.07-0.99; p 0.048) and statin therapy (hazard ratio, 0.43; 95% confidence interval, 0.25-0.73; p 0.002) correlated inversely with major cardiovascular events and death. In the Kaplan-Meier analysis, cumulative event-free rates were significantly lower among patients with EPA/AA ratio 0.33 and patients without statin therapy (p 0.006). Conclusions: Low EPA/AA ratio at baseline and treatment without statins could predict mortality, recurrent ischemic stroke, cardiovascular and peripheral artery diseases, and hemorrhagic stroke among patients with acute ischemic stroke. The combination of baseline EPA/AA ratio and statin therapy could be critical in predicting the long-term prognosis of ischemic stroke patients. ischemic stroke patients 2, 3). Polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA) are poorly synthesized in the human body. Intake of EPA is well-known to reduce the incidence of cardiovascular and cerebrovascular diseases 4-7). The protective roles against cardiovascular disease attributed to n-3 PUFAs could be due to interactions of a number of pleiotropic effects, including anti-inflammatory, anti-atherogenic, anti-Copyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

Enhanced Production of EPA-Derived Anti-Inflammatory Metabolites after Oral Administration of a Novel Self-Emulsifying Highly Purified EPA Ethyl Ester Formulation (MND-2119)

“…In a Japanese community, the serum EPA/arachidonic acid (AA) ratio decreased over 10 years 2) . Previous studies showed that a lower serum EPA/AA ratio is predictive of the incidence of cardiovascular events [3][4][5][6] . The JELIS and REDUCE-IT trials verified that highly purified EPA ethyl ester (EPA-E) reduced the risk of cardiovascular events 7,8) .…”

Association between the ratio of serum eicosapentaenoic acid to arachidonic acid and risk of coronary artery disease in young Chinese patients

“…Therefore, the ratio of omega-3/omega-6 PUFA may reflect the balance of anti-inflammatory and proinflammatory fatty acids in circulation, which may significantly relate to cardiovascular risk. Observational studies from Japan, a country with a large amount of seafood intake, showed that a low EPA/AA ratio is associated with an increased risk of CVD, including CAD, stroke, and PAD (6)(7)(8)(9), especially in young individuals. However, whether such association was true in the Chinese population was still unclear.…”

Serum Fatty Acids Are Associated with a Higher Risk of Ischemic Stroke

“…Taking into consideration that several studies showed the impact which fatty acids have on the clinical prognosis of ischemic-stroke patients by improving functional outcome, mortality, as well as their prognostic value in the long term, the attempt to influence the serum values of fatty acids and their ratios could be achieved with better control over risk factors and also over the elimination of certain risk factors, especially lifestyle risk factors such as smoking and chronic alcohol consumption [ 41 , 45 , 46 ].…”