Low Alpha-Linolenic Acid Associates With Poor Outcomes in Heart Failure

Low serum phosphatidylcholine alpha-linolenic acid levels is associated with worse prognosis in patients with heart failure (HF), according to findings published in the Journal of the American College of Cardiology.

Ambulatory patients with HF of various etiologies (N=905) who had serum samples stored were evaluated for a median follow-up period of 2.4 years. Patients had follow-up visits every 6 months. The study population was a mean [SD] age of 67 [13] years; 31.7% of participants were women. The primary outcome was a composite of all-cause mortality or first HF hospitalization.

Patients were categorized into quartiles based on serum phosphatidylcholine alpha-linolenic acid levels:

• Quartile 1: <0.081%; n=226
• Quartile 2: 0.081%-0.105%; n=227
• Quartile 3: 0.106%-0.138%; n=226
• Quartile 4: ³0.139%; n=226

Stratified by quartile, the patient groups differed significantly by age (P =.003), estimated glomerular filtration rate (P =.029), eicosapentaenoic acid (EPA) in serum phosphatidylcholine (P <.001), and docosahexaenoic acid (DHA) plus EPA in serum phosphatidylcholine (P =.009).

After a follow-up period of 2.4 (range, 0.02-3) years, 140 all-cause deaths were documented, along with 85 cardiovascular deaths, 141 first HF hospitalizations.

The multivariate analysis revealed that patients categorized in quartiles 2, 3, and 4 have a 39% reduced risk of experiencing the primary outcomes (hazard ratio [HR], 0.61; 95% CI, 0.46-0.81; P =.001) compared to patients categorized in quartile 1. Stratified by individual endpoints, patients in quartiles 2 through 4 also experienced a decreased risk for all-cause mortality (HR, 0.58; 95% CI, 0.41-0.82; P =.002), cardiovascular death (HR, 0.51; 95% CI, 0.32-0.80; P =.004), first HF hospitalization (HR, 0.58; 95% CI, 0.40-0.84; P =.003), and cardiovascular death plus HF hospitalization (HR, 0.58; 95% CI, 0.42-0.79; P =.001) compared with patients in quartile 1.

Study authors found that EPA, DHA, and EPA plus DHA levels in serum phosphatidylcholine were not significantly different between patients in quartile 1 vs 2 through 4.

Study limitations include unknown causes of low serum phosphatidylcholine alpha-linolenic acid levels, limited extrapolation to patients with HF outside of the study demographics, and unknown dietary data from patients.

These data indicated that patients with HF who had the low phosphatidylcholine alpha-linolenic acid levels were associated with poorer outcomes, including mortality, compared with their counterparts. These findings may suggest that patients with low alpha-linolenic acid levels could benefit from an alpha-linolenic acid-improving dietary intervention.

“[E]levated ALA [alpha-linolenic acid] levels in serum phospholipids, which mirror dietary intake, were related to a lower risk of incident adverse clinical outcomes during a mid-term follow-up in patients with HF,” the study authors concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.