Correlation of erythrocyte fatty acid composition and dietary intakes with markers of atherosclerosis in patients with myocardial infarction
Introduction
The long chain n-3 polyunsaturated fatty acids such as eicosapentaenoic acid (20:5n3, EPA) and docosahexaenoic acid (22:6n3, DHA) reduces the risk for coronary heart disease (CHD) [1]. The DART [2], GISSI-Prevenzione [3], and JELIS [4] studies have shown that oily fish, EPA and DHA, and EPA alone can significantly reduce cardiac death and cardiovascular events, but it has not been established whether these effects include preventing atherosclerosis. In 1975, Dyerberg et al [5] observed that coronary atherosclerosis was almost unknown among Greenlandic Eskimos living in their indigenous environment and that they consume large amounts of n-3 fatty acids from fish and marine mammals [6]. The mechanisms for the protection offered by n-3 fatty acids against CHD that has been observed in clinical trials may involve reduced myocardial susceptibility to lethal arrhythmias [7] and enhanced plaque stability [8]. In contrast to n-3 fatty acids, trans-fatty acids cause profound atherogenic profiles by altering lipids, endothelial function, and inflammatory markers [9], [10], [11].
The carotid intima medial thickness (IMT) is a well-established marker of the progression of atherosclerosis [12]. People with a greater intake of n-3 fatty acids, either as fish [13], [14] or EPA [15], have significantly thinner IMT than those that intake less, whereas an intake of trans-fatty acids is positively associated with IMT thickness [16]. Sekikawa et al [17] reported a significant inverse association between IMT and serum n-3 fatty acid levels only in Japanese but not in whites or Japanese Americans. The association between fatty acids and Gensini score, which is a noninvasive measurement that relates to the extent and severity of coronary atherosclerosis, has not been studied. Adams et al [18] reported that the carotid IMT is correlated with the Gensini score, which can be used as a surrogate marker for coronary atherosclerosis. However, there are no data that show the relationship between tissue levels of fatty acid and the IMT or Gensini score.
Epidemiological studies have indicated that diets that are particularly high in fruits and vegetables are associated with coronary atherosclerosis [19], [20]. Ellingsen et al [21] suggested that the consumption of fruits is associated with carotid IMT. The biological mechanisms whereby fruits and vegetables may exert their effects are not entirely clear, but many nutrients, such as antioxidants and vitamins, may be involved [22]. However, studies that directly relate diet to atherosclerosis in the carotid arteries as assessed by IMT seem to be lacking. The present study was undertaken to examine the hypothesis that diets low in n-3 fatty acids and high in trans-fatty acids and intakes of fats, vitamins, and minerals were associated with the extent of atherosclerosis in the carotid arteries of patients with myocardial infarction.
Section snippets
Subjects
Recruited subjects were patients who were admitted to the Hanyang University Kuri Hospital (Kuri, South Korea) with their first acute myocardial infarction between November 2006 and May 2008. Patients were diagnosed with their first case of ST-segment elevated myocardial infarction and excluded if they had a history of CHD, cancer, hyperlipidemia, or diabetes. Characteristics of 50 patients were obtained from reviewing the medical charts and interview and presented in Table 1. This study was
Results and discussion
Female patients were significantly older than male subjects, but the extent of atherosclerosis and nutrient intakes were not (Table 1). Table 2 shows correlates of IMT stratified by erythrocyte fatty acid composition based on linear regression analysis after adjusting for age and sex. Only the trans-oleic acid (elaidic acid or t18:1n9) was significantly and positively correlated with IMT. Gensini score was not significantly correlated with any of the fatty acids measured in erythrocyte (data
Acknowledgment
This work was supported by the Korean Research Foundation grant that is funded by the Korean Government (MOEHD, Basic Research Promotion Fund, KRF-2007-331-C00279). The authors state that there are no conflicts of interest.
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