Low levels of serum n-3 polyunsaturated fatty acids are associated with worse heart failure-free survival in patients after acute myocardial infarction

Circ J. 2013;77(1):153-62. doi: 10.1253/circj.cj-12-0875. Epub 2012 Oct 6.


Background: Intake of long-chain n-3 polyunsaturated fatty acids (n-3 PUFA), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), is associated with a lower risk of atherosclerotic cardiovascular events, particularly acute myocardial infarction (AMI). However, limited data are available regarding the association between serum n-3 PUFA levels and heart failure (HF) events in survivors of AMI.

Methods and results: We evaluated whether serum DHA and EPA levels were associated with HF-free survival and HF hospitalization rates after AMI. A total of 712 patients were divided into 3 groups according to their tertile serum levels of DHA and EPA (Low, Middle, and High). Propensity-score-stratified Cox regression analysis revealed that DHA- and EPA-Low groups presented statistically significant worse HF-free survival (hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.03-2.72, P=0.0358, and HR 1.69, 95% CI 1.05-2.72, P=0.0280, respectively), with the EPA-Low group having a higher risk of HF hospitalization (HR 2.40, 95% CI 1.21-4.75, P=0.0097) than the DHA-Low group (HR 1.72, 95% CI 0.86-3.45, P=0.1224). The relationship between a low DHA or EPA level and decreased HF-free survival was almost common to all subgroups; however, the effect of low serum EPA on HF hospitalization was prominent in male patients, and those with low levels of high-density lipoprotein cholesterol or without statin therapy.

Conclusions: Low levels of circulating n-3 PUFA are associated with decreased HF-free survival in post-AMI patients.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Disease-Free Survival
  • Docosahexaenoic Acids / blood*
  • Eicosapentaenoic Acid / blood*
  • Female
  • Heart Failure* / blood
  • Heart Failure* / etiology
  • Heart Failure* / mortality
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction* / blood
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / mortality
  • Sex Factors
  • Survival Rate


  • Docosahexaenoic Acids
  • Eicosapentaenoic Acid