title: Ratio of eicosapentaenoic acid to arachidonic acid is a critical risk factor for acute coronary syndrome in middle-aged older patients as well as younger adult patients.
abstract: BACKGROUND
  Coronary risk factors for the onset of acute coronary syndrome (ACS), including polyunsaturated fatty acids (PUFAs), in younger adult patients may be different from those in older patients.
  
  
  RESULTS
  We enrolled 578 patients who underwent coronary angiography at Fukuoka Saiseikai Hospital, and divided them into a younger adult group (YG) (<50 years, n=47) and a middle-aged older group (OG) (≥50 years, n=531). In a multivariate analysis, lower levels of high-density lipoprotein cholesterol and the ratio of eicosapentaenoic acid (EPA) to arachidonic acid (AA) (EPA/AA), and less aspirin, oral hypoglycemic agent, and calcium channel blocker (CCB) use were independent risk factors for ACS in all patients. In YG, lower levels of EPA/AA and less angiotensin II receptor blocker/angiotensin-converting enzyme inhibitor use were the independent risk factors. In OG, smoking, lower levels of EPA/AA, less aspirin and CCB use were the risk factors. While lower levels of EPA/AA was the only risk factor for ACS that was common to all patients, YG and OG, docosahexaenoic acid/AA was not associated with ACS in YG and OG.
  
  
  CONCLUSIONS
  Lower level of EPA/AA is a common critical risk factor for ACS in middle-aged older patients as well as younger adult patients. Some of the risk factors for the onset of ACS in younger patients were different from those in older patients.
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Serikawa
authors.affiliation: Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan. Electronic address: miuras@cis.fukuoka-u.ac.jp.
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Miura
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Okabe
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hongo
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tokutome
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yoshikawa
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Takesue
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Sen
authors.initials: S
authors.lastname: Adachi
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Kunpei
authors.initials: K
authors.lastname: Osaka
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Matsukawa
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Daizaburo
authors.initials: D
authors.lastname: Yanagi
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Nozoe
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kozai
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hironaga
authors.affiliation: Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan. Electronic address: saku-k@fukuoka-u.ac.jp.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Saku
authors.affiliation: Division of Cardiology, Fukuoka Saiseikai Hospital, Fukuoka 810-0001, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists; D016718:Arachidonic Acid / Q000097:blood*; D001241:Aspirin; D002121:Calcium Channel Blockers; D008076:Cholesterol, HDL / Q000097:blood; D017023:Coronary Angiography; D004365:Drugs, Chinese Herbal; D015118:Eicosapentaenoic Acid / Q000097:blood*; D028001:Eleutherococcus; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012907:Smoking
chemical_list: D057911:Angiotensin Receptor Antagonists; D002121:Calcium Channel Blockers; D008076:Cholesterol, HDL; D004365:Drugs, Chinese Herbal; D007004:Hypoglycemic Agents; D016718:Arachidonic Acid; D015118:Eicosapentaenoic Acid; D001241:Aspirin; C400150:Acanthopanax gracilistylus, extract
keywords: Acute coronary syndrome; Coronary angiography; Docosahexaenoic acid; Eicosapentaenoic acid; Polyunsaturated fatty acids