Higher EPA levels and EPA/DHA Ratios Are associated with Lower Cardiovascular Mortality Post-Myocardial Infarction

Damien Leleu; Michel Farnier; Frédéric Chagué; David Palleschi; Margot Machado; Marine Gougeon; Jean-Paul Pais de Barros; Maxime Nguyen; Florence Bichat; Maud Maza; Yves Cottin; David Masson; Marianne Zeller

doi:10.1093/eurjpc/zwaf673

Higher EPA levels and EPA/DHA Ratios Are associated with Lower Cardiovascular Mortality Post-Myocardial Infarction

Eur J Prev Cardiol. 2025 Oct 14:zwaf673. doi: 10.1093/eurjpc/zwaf673. Online ahead of print.

Authors

Damien Leleu^{1

2

3

4}, Michel Farnier⁵, Frédéric Chagué⁶, David Palleschi⁴, Margot Machado⁴, Marine Gougeon⁴, Jean-Paul Pais de Barros^{1

2

3

4}, Maxime Nguyen^{1

2

3

4}, Florence Bichat⁶, Maud Maza⁶, Yves Cottin⁶, David Masson^{1

2

3

4}, Marianne Zeller^{5

6}

Affiliations

¹ Université Bourgogne Europe LNC UMR1231, Dijon, France.
² INSERM, UMR1231, Dijon, France.
³ LipSTIC LabEx, Dijon, France.
⁴ Laboratory of Clinical Chemistry, CHU Dijon Bourgogne, France.
⁵ Physiopathologie et Epidémiologie Cérébro-Cardiovasculaire (PEC2), EA 7460, Université Bourgogne Europe, France.
⁶ Cardiology Department, CHU Dijon Bourgogne, France.

PMID: 41092095
DOI: 10.1093/eurjpc/zwaf673

Abstract

Background: The efficacy of omega-3 fatty acid supplementation in cardiovascular prevention remains debated. Observational data suggest that individual fatty acids may have distinct prognostic value after acute myocardial infarction (AMI).

Objectives: To analyze the association of plasma fatty acid (FA) levels including eicosapentaenoic acid (EPA) and the EPA/docosahexaenoic acid (DHA) ratio at the time of AMI with one-year cardiovascular (CV) mortality.

Methods and results: This prospective study included 572 patients hospitalized for AMI. Plasma FA levels were measured using gas chromatography coupled with mass spectrometry. The associations between FA profiles and CV mortality at one-year follow-up were analyzed using Cox proportional hazards models. At follow-up, 29 deaths were cardiovascular-related. Patients who died had lower relative levels of EPA (0.47% (0.28-0.73) vs. 0.73% (0.52-1.02), p<0.001), a lower EPA/DHA ratio (0.33 (0.22-0.43) vs. 0.44 (0.33-0.61) p<0.001), and more elevated levels of inflammatory biomarkers, including hs-CRP and interleukin-1β. In contrast, DHA levels were not associated with CV mortality. In multivariate analysis, the EPA/DHA ratio was associated with lower CV mortality, even after adjustment for confounding factors including GRACE risk score, left ventricular ejection fraction, and inflammatory biomarkers.

Conclusion: Our study demonstrates that higher plasma levels of EPA and EPA/DHA ratio are associated with lower CV mortality one year after AMI.

Keywords: acute myocardial infarction; cardiovascular mortality; docosahexaenoic acid (DHA); eicosapentaenoic acid (EPA); hs-C-reactive protein (CRP); inflammation; interleukin-1β (IL-1β); omega-3 fatty acid.

Plain language summary

It is debated whether pharmacologic administration of omega-3 fatty acids, including eicosapentaenoic acid (EPA), could reduce the incidence of acute myocardial infarction (AMI). We aimed to analyze the association between circulating levels of EPA and the prognosis after an AMIIn this prospective cohort of patients with AMI, we found that higher plasma levels of EPA were associated with reduced one-year cardiovascular mortality.These associations remained significant after adjustment for established prognostic factors and inflammatory biomarkersThese findings support evidence of the atheroprotective effects of EPA and the potential benefits of EPA supplementation during the acute phase of MI.