heart failure (HF) Patients with higher serum levels of alpha-linolenic acid (ALA) had a better prognosis than those with the lowest levels in an observational study.
ALA is an omega-3 fatty acid that is primarily found in plants, including flaxseedOr shea, walnut, or canola oil.
“The finding most surprising to us is the apparent difference between patients in the lower quartile compared to the other 75%, indicating a putative effect threshold for ALA, reinforcing the notion that ‘one volume does not fill the whole,’” Sala Villa, MD, PhD, said. From the Hospital del Mar Medical Research Institute (IMIM) in Barcelona, theheart.org | Medscape Heart.
analysis that was Posted online October 24 in Journal of the American College of Cardiology, showed a statistically significant reduction in all-cause mortality, cardiovascular (CV) mortality, and first hospitalization from HF among those in the top three quartiles of serum ALA levels compared with those in the lowest quartile.
the team previous discovery That higher levels of phosphatidylcholine eicosapentaenoic acid (PC EPA) and ALA were associated with a lower risk of adverse events in patients with ST segment elevation. myocardial infarction Sala Villa paid the current study.
Although their findings generate hypotheses at this point, he added, “The inclusion of certain ALA-rich foods, such as walnuts, in an individual’s diet, whether they have HF or not, may translate into CV benefits, to Assumptions side. Effect on HF. There is no evidence of any adverse effect of one daily serving of walnuts, not even on weight gain.”
Sala-Vila and colleagues analyzed data and samples from 905 patients (mean age, 67; 32% women) with HF of different etiologies. ALA was assessed by gas chromatography in serum phospholipids, which reflects long-term dietary ALA intake and metabolism.
The primary outcome was a composite of all causes of death or first hospitalization for treatment. The secondary outcome was composite death from CV or HF hospitalization.
After a median follow-up of 2.4 years, 140 all-cause deaths occurred, 85 cardiac deaths, and 141 first-time hospital admissions (compound of all-cause death and first-time hospital admission, 238; composite of CV death and hospital admission H.F., 184).
Compared with patients in the lowest quartile of serum ALA in serum phospholipids, those in the top three quartiles showed a 39% reduction in risk of the primary endpoint (hazard ratio). [HR]0.61).
Statistically significant decreases in all-cause mortality (HR, 0.58), CV mortality (HR, 0.51), first HF hospitalization (HR, 0.58), and the composite of CV death and HF hospitalization (HR, 0.58) were also observed.
By contrast, non-statistically significant associations were seen for fish-derived EPA, DHA, and total EPA + DHA.
Limitations of the study include its supervisory nature; Relatively small group with low or mid-range ejection fraction and 2 . stage Chronic kidney failure; There are no nutritional data except for those related to fatty acids.
Sala Villa noted that “controversial results from recent historical trials on omega-3s have translated into confusion/negative impact on the reputation of these fatty acids.” “Many factors influence how each participant responds to a particular intervention (micronutrition), such as genes, microbiome and environment. In this regard, nutritional status – the omega-3 background – emerges as a key determinant.”
Randomized trials are required
Comment on the study for theheart.org | Medscape Heart, Manson, MD, Master of Public Health, Dr.
These studies include GISSI-HF Historical ExperienceA randomized controlled trial (RCT) showed a small benefit of n-3 polyunsaturated fatty acids regarding hospitalization and mortality among patients with chronic HF and her team. VITAL-HF . Studywhich showed a significant reduction in HF with marine omega-3 supplementation versus placebo.
“This may not be a causal association, and the authors acknowledge that they have no information on other dietary factors,” Manson said. “Foods that raise the level of ALA in the blood may include the type of plant-based diet that has been linked to a lower risk of cardiovascular disease, such as the Mediterranean diet. The results may also be the result of other factors that are not fully controlled in the analysis, or participants could be more compliant with their medication.”
However, she said, “It is reasonable to recommend that people with a history of HF or at high risk of HF increase their intake of ALA-rich foods, including canola oil, flaxseed and soybean oils, soybean oils, and walnuts.”
“I think the evidence is promising enough that a randomized controlled trial of ALA in people with heart failure would also be reasonable,” she added.
Similarly, Abdullah Al-Mohammed, MD, of Northern General Hospital in Sheffield, UK, wrote in a Related editing that while the potential role of ALA in improving morbidity and mortality in HF patients cannot be demonstrated yet, the findings “open the door to further questions” that “the judge and jury will be … randomized controlled trials.”
No commercial financing or related conflicts of interest have been declared.
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