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: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: xxxyasunagaxxx@e-mail.jp.
authors.forename: Yasuomi
authors.initials: Y
authors.lastname: Nagahara
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: sadakom@fujita-hu.ac.jp.
authors.forename: Sadako
authors.initials: S
authors.lastname: Motoyama
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: msarai@fujita-hu.ac.jp.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Sarai
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: pole1207@hotmail.co.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: hidekikawai@xc4.so-net.ne.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawai
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: youkot@fujita-hu.ac.jp.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Takakuwa
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: mmiyagi@fujita-hu.ac.jp.
authors.forename: Meiko
authors.initials: M
authors.lastname: Miyagi
authors.affiliation: Department of Radiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: dshibata@fujita-hu.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shibata
authors.affiliation: Division of Medical Statistics, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: hirotaka@fujita-hu.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: hnaruse@fujita-hu.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Naruse
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: jishii@fujita-hu.ac.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishii
authors.affiliation: Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. Electronic address: ozakiyuk@fujita-hu.ac.jp.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood; D000368:Aged; D016718:Arachidonic Acid / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D003324:Coronary Artery Disease / Q000097:blood*; D015118:Eicosapentaenoic Acid / Q000097:blood*; D015525:Fatty Acids, Omega-3 / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic / Q000097:blood*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D015525:Fatty Acids, Omega-3; D016718:Arachidonic Acid; D002097:C-Reactive Protein; D015118:Eicosapentaenoic Acid
keywords: Coronary CT; Coronary artery disease; EPA/AA; High risk plaque