Serum omega-3 from plants may improve prognosis in HF
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Increased circulating plant-derived omega-3, known as alpha-linolenic acid, was associated with reduced risk for all-cause death or first HF hospitalization in ambulatory patients with HF, researchers reported.
“In contrast to marine-derived counterparts, the association between dietary alpha-linolenic acid, the main plant omega-3, and HF prognosis remains to be explored,” Iolanda Lázaro, PhD, research fellow in cardiovascular risk and nutrition at Hospital del Mar Medical Research Institute in Barcelona, Spain, and colleagues wrote in a study published in the Journal of the American College of Cardiology. “Given the increasing evidence that adhering to predominant plant-based dietary patterns (ie, Mediterranean diet or Dietary Approaches to Stop Hypertension) may be optimal for patients with HF, we hypothesized that, in patients with HF, regular consumption of foods rich in alpha-linolenic acid, the plant omega-3, would translate into a reduced risk of morbidity and mortality.”
To better understand the relationship between dietary alpha-linolenic acid and HF prognosis, researchers in Spain evaluated serum phospholipids using gas chromatography in 905 ambulatory patients with HF of different etiologies (mean age, 67 years; 31.7% women).
Participants were stratified into quartiles based on the percentage of alpha-linolenic acid within their serum phosphatidylcholine.
The primary outcome was a composite of all-cause death or first HF hospitalization and the median follow-up was 2.4 years.
Alpha-linolenic acid and HF prognosis
Compared with the lowest quartile of alpha-linolenic acid, patients in quartiles two, three and four had an approximately 39% lower risk for the primary endpoint (HR = 0.61; 95% CI, 0.46-0.81; P = .001).
Compared with those in the lowest quartile, those with greater serum alpha-linolenic acid level had lower risk for:
- all-cause death (HR = 0.58; 95% CI, 0.41-0.82; P = .002);
- CV death (HR = 0.51; 95% CI, 0.32-0.8; P = .004);
- first HF hospitalization (HR = 0.58; 95% CI, 0.4-0.84; P = .003); and
- the composite of CV death and HF hospitalization (HR = 0.58; 95% CI, 0.42-0.79; P = .001).
In other findings, researchers observed no significant association between levels of fish-derived omega-3s — eicosapentaenoic acid, docosahexaenoic acid and their sum — with the primary outcome when comparing the lowest with the higher quartiles.
“These findings would hopefully pave the way for future trials testing whether regular consumption of foods rich in alpha-linolenic acid could serve as a preventive strategy to improve outcomes and promote quality of life in patients with HF and low circulating alpha-linolenic acid, and thus contribute to reducing the socioeconomic burden of this global public health concern,” the researchers wrote.
Data ‘hypothesis-generating,’ clinical trials needed
In a related editorial, Abdallah Al-Mohammad, MD, consultant cardiologist and lead heart failure cardiologist at Northern General Hospital in Sheffield, U.K., discussed the potential mechanisms by which alpha-linolenic acid could improve HF prognosis and recommended caution when interpreting these findings.
“One postulates a potential mechanism for alpha-linolenic acid exerting its effect on the heart via the inflammatory processes that lead to HF morbidity and mortality; this concept may not be far from what we learned from the story of mineralocorticoid receptor antagonists,” Al-Mohammad wrote.
“The findings of Lázaro et al are hypothesis-generating. Their proposal of a potential role for this source of nutrition in improving the morbidity and mortality rates of patients with HF cannot yet be substantiated. The weak basic scientific evidence is not sufficient to justify their optimism,” Al-Mohammad wrote. “The study ... opens the field to more questions, particularly whether circulating plant-based omega-3 levels in HF are prognostic risk markers or therapeutic targets. The judge and jury for these cases shall be prospective randomized controlled clinical trials.”
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