Higher Plasma Eicosapentaenoic Acid Linked to Lower Risk for Heart Failure

heart failure, dilated cardiomyopathy
Higher plasma eicosapentaenoic acid was significantly associated with reduced risk for heart failure.

An association has been identified between higher plasma eicosapentaenoic acid (EPA) and lower risk for heart failure, according to a study recently published in JACC: Heart Failure. This association has been linked with both heart failure with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF).

This study included 6562 participants (52% women) whose plasma EPA abundance (%EPA) was measured at baseline. Of these, 2532 were white, 1794 were black, 1442 were Hispanic, and 794 were Chinese. Median follow up was 13 years, and study-related visits were scheduled approximately every other year.

Participant data were sourced from the Multi-Ethnic Study of Atherosclerosis (MESA; ClinicalTrials.gov identifier: NCT00005487), in which plasma phospholipid EPA was tested using Cox proportional hazards modeling for its prognostic power for HFrEF (EF<45%) and HFpEF (EF≥45%). 

During follow up, there were 292 instances of heart failure (HFrEF, 128; HFpEF, 110; unknown ejection fraction status, 54). The highest %EPA levels were found among Chinese participants (9.8%), followed by whites (4.9%), blacks (4.4%), and Hispanics (1.4%).

Those who did not experience heart failure had 0.76% (0.75%-0.77%) EPA, and those with heart failure had 0.69% (0.64%-0.74%) EPA (P =.005). Lower frequency of heart failure correlated with log %EPA, with a hazard ratio of 0.73 (95% CI, 0.60-0.91) per log-unit %EPA difference (P =.004).

This relationship was not affected by adjustments for sex, age, body mass index, race, diabetes mellitus, smoking status, lipids and lipid-lowering drugs, blood pressure, or albuminuria. Sensitivity analyses revealed that heart failure type was not an influencing factor.

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Limitations to this study included a small number of participants with HFpEF and protective EPA levels, a lack of data on omega-3 polyunsaturated fatty acid (PUFA) changes, inability to determine a %EPA threshold, and the interchangeable use of red blood cell and plasma phospholipid abundance in the study’s discussion.

Study researchers concluded that “plasma phospholipid [EPA abundance] is inversely associated with all [heart failure] incidence, both HFpEF and HFrEF. In contrast to findings in animals, the inverse association was also found for other [omega-3] PUFAs and was strongest for the combined [abundances in EPA and docosahexaenoic acid (or %EPA+%DHA)].”

Disclosure: David M. Herrington, MD, Timothy D. O’Connell, PhD, and Gregory C. Shearer, PhD, received honoraria for training and advice from Amarin Pharmaceuticals.


Block RC, Liu L, Herrington DM, et al. Predicting risk for incident heart failure with omega-3 fatty acids: from MESA [published online July 3, 2019]. JACC Heart Fail. doi:10.1016/j.jchf.2019.03.008