Relationship of Circulating Vegetable Omega-3 to Prognosis in Patients With Heart Failure

J Am Coll Cardiol. 2022 Nov 1;80(18):1751-1758. doi: 10.1016/j.jacc.2022.08.771.


Background: There is an urgent need for cost-effective strategies to promote quality of life in patients with heart failure (HF). Several studies reported benefits in HF prognosis for marine omega-3 fatty acids and plant-based dietary patterns.

Objectives: The aim of this study was to explore whether dietary alpha-linolenic acid (ALA), the main plant omega-3, relates to a better HF prognosis.

Methods: ALA was determined in serum phospholipids (which reflect long-term dietary ALA intake and metabolism) by gas chromatography in 905 ambulatory patients with HF caused by different etiologies.

Results: After a median follow-up of 2.4 years (range: 0.02-3 years), 140 all-cause deaths, 85 cardiovascular (CV) deaths, and 141 first HF hospitalizations (composite of all-cause death and first HF hospitalization, n = 238) were documented. Using Cox regression analyses, we observed that, compared with patients at the lowest quartile of ALA in serum phospholipids (Q1), those at the 3 upper quartiles (Q2-Q4) exhibited a reduction in the risk of composite of all-cause death and first HF hospitalization (HR: 0.61; 95% CI: 0.46-0.81). Statistically significant reductions were observed for all-cause death (HR: 0.58; 95% CI: 0.41-0.82), CV death (HR: 0.51; 95% CI: 0.32-0.80), first HF hospitalization (HR: 0.58; 95% CI: 0.40-0.84), and the composite of CV death and HF hospitalization (HR: 0.58; 95% CI: 0.42-0.79).

Conclusions: HF patients with bottom 25% ALA levels in serum phospholipids had a worse prognosis during a mid-term follow-up compared with those with the highest levels. This might be a target population in whom to test dietary ALA-rich interventions to promote quality of life.

Keywords: alpha-linolenic acid; diet; flaxseed; lifestyle; nutrition; walnuts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Fatty Acids, Omega-3*
  • Heart Failure* / etiology
  • Hospitalization
  • Humans
  • Phospholipids
  • Prognosis
  • Quality of Life
  • Vegetables


  • Fatty Acids, Omega-3
  • Phospholipids