title: The ratio of serum n-3 to n-6 polyunsaturated fatty acids is associated with diabetes mellitus in patients with prior myocardial infarction: a multicenter cross-sectional study.
abstract: In prior myocardial infarction (PMI) patients, diabetes mellitus (DM), dyslipidemia, and hypertension increase the risk of secondary cardiovascular events. Although a decreased ratio of serum eicosapentaenoic acid (EPA) to arachidonic acid (AA; EPA/AA) has been shown to significantly correlate with the onset of acute coronary syndrome, the associations between polyunsaturated fatty acid (PUFA) levels and coronary risk factors in PMI patients have not been evaluated thoroughly. This study aimed to assess the associations between PUFAs levels and the risk factors in PMI patients.
  
  
  
  We enrolled 1733 patients with known PUFA levels who were treated in five divisions of cardiology in a metropolitan area of Japan, including 303 patients with PMI. EPA/AA and docosahexaenoic acid (DHA) to AA level ratio (DHA/AA) in patients with and without PMI were analyzed according to presence of coronary risk factors.
  
  
  
  Diabetes patients with PMI had significantly lower EPA/AA and DHA/AA than diabetes patients without PMI (EPA/AA: P <0.01; DHA/AA: P =0.003), with no such differences in dyslipidemia and hypertension patients. In DM patients with high high-sensitivity C-reactive protein (hs-CRP) levels (>0.1 mg/dL), EPA/AA was low in individuals who also had PMI, whereas DHA/AA was not (EPA/AA, with PMI: 0.43 ± 0.24; without PMI: 0.53 ± 0.30, P < 0.05). Moreover, patients on statins had significantly lower DHA/AA ratios, whereas the EPA/AA ratio did not depend on statin use. Multiple regression analysis revealed that statin use in DM patients was associated with low DHA/AA but not EPA/AA.
  
  
  
  PMI patients with DM have low EPA/AA and DHA/AA. EPA/AA and DHA/AA are differently related to hs-CRP level in DM patients with PMI. Statin use can potentially affect DHA/AA but not EPA/AA, and therefore EPA/AA ratio is a better marker of assessment for cardiovascular events.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan. masaotakahashi-gi@umin.org.
authors.forename: Masao
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Ando
authors.affiliation: Department of Cardiology, Juntendo University Graduate School of Medicine, Hongo 3-1-3, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Cardiology, Juntendo University Graduate School of Medicine, Hongo 3-1-3, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishizaki
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, Nishishinbashi 3-19-18, Minato-ku, Tokyo, 105-8471, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ogawa
authors.affiliation: Department of Cardiology, Sempo Takanawa Hospital, Takanawa 3-10-11, Minato-ku, Tokyo, 108-8606, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Yamamoto
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, 30-1Ohyaguchi 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, Nishishinbashi 3-19-18, Minato-ku, Tokyo, 105-8471, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Department of Cardiology, Juntendo University Graduate School of Medicine, Hongo 3-1-3, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
authors.affiliation: Jichi Medical University, Yakushiji 3311-159, Shimotsuke city, Tochigi, 329-0498, Japan.
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D000368:Aged; D016718:Arachidonic Acid / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D004281:Docosahexaenoic Acids / Q000097:blood*; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015118:Eicosapentaenoic Acid / Q000097:blood*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014041:Tokyo / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018836:Inflammation Mediators; D004281:Docosahexaenoic Acids; D016718:Arachidonic Acid; D002097:C-Reactive Protein; D015118:Eicosapentaenoic Acid
keywords: Diabetes mellitus (DM); Eicosapentaenoic acid (EPA); High-sensitivity C-reactive protein (hs-CRP); Inflammation; Polyunsaturated fatty acids (PUFAs); Prior myocardial infarction (PMI); Statin