Eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio as an associated factor of high risk plaque on coronary computed tomography in patients without coronary artery disease

Yasuomi Nagahara, Sadako Motoyama, Masayoshi Sarai, Hajime Ito, Hideki Kawai, Yoko Takakuwa, Meiko Miyagi, Daisuke Shibata, Hiroshi Takahashi, Hiroyuki Naruse, Junichi Ishii, Yukio Ozaki

Research output: Contribution to journalArticle

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Abstract

Background and aims: Coronary computed tomography angiography (CCTA)-verified high risk plaque (HRP) characteristics including positive remodeling and low attenuation plaque have been associated with acute coronary syndromes. Several studies reported that the n-3 polyunsaturated fatty acids have been associated with cardiovascular events. However, the relationship between serum eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio and CCTA-verified HRP in patients without known coronary artery disease (CAD) is unclear. We aimed at investigating the relation between EPA/AA and CCTA-verified HRP in patients without known CAD. Methods: We included 193 patients undergoing CCTA without known CAD (65.5 ± 12.0 years, 55.0% male). No patient has been treated with EPA. The relation of coronary risk factors, lipid profile, high-sensitivity C-reactive protein, coronary artery calcification score (CACS), number of vessel disease, plaque burden, and EPA/AA with the presence of HRP was evaluated by logistic regression analysis. Incremental value of EPA/AA to predict HRP was also analyzed by C-index, NRI, and IDI. A Cox proportional hazards model was used to estimate the time to cardiovascular event. Results: HRP was observed in 37 (19%) patients. Multivariable logistic regression analysis revealed that current smoking (OR 2.58; p = 0.046), number of vessel disease (OR 1.87; p = 0.031), and EPA/AA ratio (OR 0.65; p = 0.0006) were independent associated factors of HRP on CCTA. Although the addition of EPA/AA to the baseline model did not significantly improve C-index, both NRI (0.60, p = 0.0049) and IDI (0.054, p = 0.0072) were significantly improved. Patients with HRP had significantly higher rate of events compared with patients without HRP (14% vs. 3%, Logrank p = 0.0004). On multivariable Cox hazard analysis, baseline EPA/AA ratio was an independent predictor (HR 0.57, p = 0.047). Conclusions: Low EPA/AA was an associated factor of HRP on CCTA in patients without CAD. In addition to conventional coronary risk factors and CACS, EPA/AA and CCTA might be useful for risk stratification of CAD.

Original languageEnglish
Pages (from-to)30-37
Number of pages8
JournalAtherosclerosis
Volume250
DOIs
Publication statusPublished - 01-07-2016

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Eicosapentaenoic Acid
Arachidonic Acid
Coronary Artery Disease
Tomography
Coronary Vessels
Logistic Models
Regression Analysis
Omega-3 Fatty Acids
Acute Coronary Syndrome
Computed Tomography Angiography
Proportional Hazards Models
C-Reactive Protein
Smoking
Lipids

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Nagahara, Yasuomi ; Motoyama, Sadako ; Sarai, Masayoshi ; Ito, Hajime ; Kawai, Hideki ; Takakuwa, Yoko ; Miyagi, Meiko ; Shibata, Daisuke ; Takahashi, Hiroshi ; Naruse, Hiroyuki ; Ishii, Junichi ; Ozaki, Yukio. / Eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio as an associated factor of high risk plaque on coronary computed tomography in patients without coronary artery disease. In: Atherosclerosis. 2016 ; Vol. 250. pp. 30-37.
@article{c1f3537f961d46a99f7d2519e01f9798,
title = "Eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio as an associated factor of high risk plaque on coronary computed tomography in patients without coronary artery disease",
abstract = "Background and aims: Coronary computed tomography angiography (CCTA)-verified high risk plaque (HRP) characteristics including positive remodeling and low attenuation plaque have been associated with acute coronary syndromes. Several studies reported that the n-3 polyunsaturated fatty acids have been associated with cardiovascular events. However, the relationship between serum eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio and CCTA-verified HRP in patients without known coronary artery disease (CAD) is unclear. We aimed at investigating the relation between EPA/AA and CCTA-verified HRP in patients without known CAD. Methods: We included 193 patients undergoing CCTA without known CAD (65.5 ± 12.0 years, 55.0{\%} male). No patient has been treated with EPA. The relation of coronary risk factors, lipid profile, high-sensitivity C-reactive protein, coronary artery calcification score (CACS), number of vessel disease, plaque burden, and EPA/AA with the presence of HRP was evaluated by logistic regression analysis. Incremental value of EPA/AA to predict HRP was also analyzed by C-index, NRI, and IDI. A Cox proportional hazards model was used to estimate the time to cardiovascular event. Results: HRP was observed in 37 (19{\%}) patients. Multivariable logistic regression analysis revealed that current smoking (OR 2.58; p = 0.046), number of vessel disease (OR 1.87; p = 0.031), and EPA/AA ratio (OR 0.65; p = 0.0006) were independent associated factors of HRP on CCTA. Although the addition of EPA/AA to the baseline model did not significantly improve C-index, both NRI (0.60, p = 0.0049) and IDI (0.054, p = 0.0072) were significantly improved. Patients with HRP had significantly higher rate of events compared with patients without HRP (14{\%} vs. 3{\%}, Logrank p = 0.0004). On multivariable Cox hazard analysis, baseline EPA/AA ratio was an independent predictor (HR 0.57, p = 0.047). Conclusions: Low EPA/AA was an associated factor of HRP on CCTA in patients without CAD. In addition to conventional coronary risk factors and CACS, EPA/AA and CCTA might be useful for risk stratification of CAD.",
author = "Yasuomi Nagahara and Sadako Motoyama and Masayoshi Sarai and Hajime Ito and Hideki Kawai and Yoko Takakuwa and Meiko Miyagi and Daisuke Shibata and Hiroshi Takahashi and Hiroyuki Naruse and Junichi Ishii and Yukio Ozaki",
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Eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio as an associated factor of high risk plaque on coronary computed tomography in patients without coronary artery disease. / Nagahara, Yasuomi; Motoyama, Sadako; Sarai, Masayoshi; Ito, Hajime; Kawai, Hideki; Takakuwa, Yoko; Miyagi, Meiko; Shibata, Daisuke; Takahashi, Hiroshi; Naruse, Hiroyuki; Ishii, Junichi; Ozaki, Yukio.

In: Atherosclerosis, Vol. 250, 01.07.2016, p. 30-37.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio as an associated factor of high risk plaque on coronary computed tomography in patients without coronary artery disease

AU - Nagahara, Yasuomi

AU - Motoyama, Sadako

AU - Sarai, Masayoshi

AU - Ito, Hajime

AU - Kawai, Hideki

AU - Takakuwa, Yoko

AU - Miyagi, Meiko

AU - Shibata, Daisuke

AU - Takahashi, Hiroshi

AU - Naruse, Hiroyuki

AU - Ishii, Junichi

AU - Ozaki, Yukio

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background and aims: Coronary computed tomography angiography (CCTA)-verified high risk plaque (HRP) characteristics including positive remodeling and low attenuation plaque have been associated with acute coronary syndromes. Several studies reported that the n-3 polyunsaturated fatty acids have been associated with cardiovascular events. However, the relationship between serum eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio and CCTA-verified HRP in patients without known coronary artery disease (CAD) is unclear. We aimed at investigating the relation between EPA/AA and CCTA-verified HRP in patients without known CAD. Methods: We included 193 patients undergoing CCTA without known CAD (65.5 ± 12.0 years, 55.0% male). No patient has been treated with EPA. The relation of coronary risk factors, lipid profile, high-sensitivity C-reactive protein, coronary artery calcification score (CACS), number of vessel disease, plaque burden, and EPA/AA with the presence of HRP was evaluated by logistic regression analysis. Incremental value of EPA/AA to predict HRP was also analyzed by C-index, NRI, and IDI. A Cox proportional hazards model was used to estimate the time to cardiovascular event. Results: HRP was observed in 37 (19%) patients. Multivariable logistic regression analysis revealed that current smoking (OR 2.58; p = 0.046), number of vessel disease (OR 1.87; p = 0.031), and EPA/AA ratio (OR 0.65; p = 0.0006) were independent associated factors of HRP on CCTA. Although the addition of EPA/AA to the baseline model did not significantly improve C-index, both NRI (0.60, p = 0.0049) and IDI (0.054, p = 0.0072) were significantly improved. Patients with HRP had significantly higher rate of events compared with patients without HRP (14% vs. 3%, Logrank p = 0.0004). On multivariable Cox hazard analysis, baseline EPA/AA ratio was an independent predictor (HR 0.57, p = 0.047). Conclusions: Low EPA/AA was an associated factor of HRP on CCTA in patients without CAD. In addition to conventional coronary risk factors and CACS, EPA/AA and CCTA might be useful for risk stratification of CAD.

AB - Background and aims: Coronary computed tomography angiography (CCTA)-verified high risk plaque (HRP) characteristics including positive remodeling and low attenuation plaque have been associated with acute coronary syndromes. Several studies reported that the n-3 polyunsaturated fatty acids have been associated with cardiovascular events. However, the relationship between serum eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio and CCTA-verified HRP in patients without known coronary artery disease (CAD) is unclear. We aimed at investigating the relation between EPA/AA and CCTA-verified HRP in patients without known CAD. Methods: We included 193 patients undergoing CCTA without known CAD (65.5 ± 12.0 years, 55.0% male). No patient has been treated with EPA. The relation of coronary risk factors, lipid profile, high-sensitivity C-reactive protein, coronary artery calcification score (CACS), number of vessel disease, plaque burden, and EPA/AA with the presence of HRP was evaluated by logistic regression analysis. Incremental value of EPA/AA to predict HRP was also analyzed by C-index, NRI, and IDI. A Cox proportional hazards model was used to estimate the time to cardiovascular event. Results: HRP was observed in 37 (19%) patients. Multivariable logistic regression analysis revealed that current smoking (OR 2.58; p = 0.046), number of vessel disease (OR 1.87; p = 0.031), and EPA/AA ratio (OR 0.65; p = 0.0006) were independent associated factors of HRP on CCTA. Although the addition of EPA/AA to the baseline model did not significantly improve C-index, both NRI (0.60, p = 0.0049) and IDI (0.054, p = 0.0072) were significantly improved. Patients with HRP had significantly higher rate of events compared with patients without HRP (14% vs. 3%, Logrank p = 0.0004). On multivariable Cox hazard analysis, baseline EPA/AA ratio was an independent predictor (HR 0.57, p = 0.047). Conclusions: Low EPA/AA was an associated factor of HRP on CCTA in patients without CAD. In addition to conventional coronary risk factors and CACS, EPA/AA and CCTA might be useful for risk stratification of CAD.

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