title: Nutritional preconditioning by marine omega-3 fatty acids in patients with ST-segment elevation myocardial infarction: A METOCARD-CNIC trial substudy.
abstract: Marine omega-3 eicosapentaenoic acid (EPA) is readily incorporated into cardiomyocyte membranes, partially displacing the omega-6 arachidonic acid (AA). Whereas AA is a substrate for pro-inflammatory eicosanoids, the release of EPA from cell membranes generates anti-inflammatory lipid mediators, contributing to the infarct-limiting effect observed experimental models. Clinical data are lacking.
  
  
  
  In this observational study conducted in 100 patients with a reperfused anterior ST-elevation myocardial infarction (STEMI), at hospital admission we quantified by gas-chromatography the red blood cell proportions of AA, EPA, and the AA:EPA ratio, a valid surrogate for cardiomyocyte membrane content. Patients underwent cardiac magnetic resonance imaging in the acute phase (one week post-STEMI), and at long-term (6 months) follow-up. Infarct size (delayed gadolinium enhancement) and cardiac function (left ventricular ejection fraction [LVEF]) were correlated with exposures of interest by multivariate regression analysis.
  
  
  
  AA:EPA ratio directly related to acute infarct size (coefficient [95% CI]: 6.19 [1.68 to 10.69], P = 0.008) and inversely to long-term LVEF (coefficient [95% CI]: − 4.02 [− 7.15 to − 0.89], P = 0.012). EPA inversely related to acute infarct size (coefficient [95% CI]: − 6.58; [− 11.46 to − 1.70]; P = 0.009), while a direct association with LVEF at follow-up (coefficient [95% CI]: 3.67 [0.25 to 7.08]; P = 0.036) was observed.
  
  
  
  A low AA:EPA ratio in red blood cells at the time of STEMI is associated with smaller acute infarct size and preserved long-term ventricular function. Our results are consistent with prior work in experimental models and add to the notion of omega-3 fatty acids as a healthy fat.
  
  
  
  http://www.clinicaltrials.gov/NCT01311700
authors.affiliation: Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.
authors.forename: Aleix
authors.initials: A
authors.lastname: Sala-Vila
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Fernández-Jiménez
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Quirón, Universidad Europea de Madrid, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Pizarro
authors.affiliation: Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Calvo
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: García-Ruiz
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Montepríncipe, Madrid, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Fernández-Friera
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Maite D
authors.initials: MD
authors.lastname: Rodriguez
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Noemí
authors.initials: N
authors.lastname: Escalera
authors.affiliation: Hospital Universitario Central de la Defensa Gómez Ulla, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Palazuelos
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Macías
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Braulio
authors.initials: B
authors.lastname: Pérez-Asenjo
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Ortiz
authors.affiliation: Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Valentín
authors.initials: V
authors.lastname: Fuster
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; IIS, Fundación Jiménez Díaz, Madrid, Spain. Electronic address: bibanez@cnic.es.
authors.forename: Borja
authors.initials: B
authors.lastname: Ibáñez
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D016718:Arachidonic Acid / Q000097:blood*; D004032:Diet; D015118:Eicosapentaenoic Acid / Q000097:blood*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D000072657:ST Elevation Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017747:Seafood; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D016718:Arachidonic Acid; D015118:Eicosapentaenoic Acid; D008790:Metoprolol
keywords: Fatty acids; Myocardial infarction; Nutrition