title: Association between the docosahexaenoic acid to arachidonic acid ratio and acute coronary syndrome: a multicenter observational study.
abstract: A low eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio is a known risk for acute coronary syndrome (ACS). However, the association between the docosahexaenoic acid (DHA) to AA ratio and ACS remains unclear. This study aimed to assess the association between the DHA/AA ratio and ACS by patient characteristics.
  
  
  
  We enrolled 1733 patients and evaluated the serum levels of polyunsaturated fatty acids in 5 cardiology departments in a metropolitan area of Japan. We assessed the relationship between the DHA/AA ratio (median cut-off value: 0.903) and ACS according to the following 10 subgroups: sex, age, diabetes mellitus, hypertension, dyslipidemia, smoking history, family history of ischemic heart disease, chronic kidney disease, obesity, and history of coronary revascularization.
  
  
  
  Interaction tests in the 10 subgroup analyses revealed a significant difference for adjusted log odds ratios between male and females (p = 0.01), and those with and without hypertension (p = 0.06). Especially in the subgroup based on sex difference, a high DHA/AA ratio was significantly associated with a low risk of ACS among men (adjusted odds ratio = 0.389; 95 % confidence interval: 0.211-0.716). In contrast, a reverse association was found among women, although this was not statistically significant (adjusted odds ratio = 3.820; 95 % confidence interval: 0.718-20.325).
  
  
  
  The association between the DHA/AA ratio and ACS differed by clinical characteristic. Notably, patients with a low DHA/AA ratio had a higher risk of ACS than those with a high DHA/AA ratio, and this was significant for men in particular.
authors.affiliation: Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishizaki
authors.affiliation: Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Cardiology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan.
authors.forename: Shigemasa
authors.initials: S
authors.lastname: Tani
authors.affiliation: Divison of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ogawa
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Ando
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Internal Medicine, Tokyo Takanawa Hospital, 3-10-11, Takanawa Minato-ku, Tokyo, 108-8606, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Biostatistics, School of Public Health, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shinozaki
authors.affiliation: Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.affiliation: Department of Cardiology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi Kamichou Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
authors.affiliation: Divison of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.affiliation: Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi-ken, 329-0498, Japan.
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
authors.affiliation: Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan. daida@juntendo.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D000368:Aged; D016718:Arachidonic Acid / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D004281:Docosahexaenoic Acids / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D004281:Docosahexaenoic Acids; D016718:Arachidonic Acid
keywords: Acute coronary syndrome; Arachidonic acid; DHA/AA ratio; Docosahexaenoic acid; EPA/AA ratio; Eicosapentaenoic acid; Polyunsaturated fatty acids