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Serum trans fatty acids, asymmetric dimethylarginine and risk of acute myocardial infarction and mortality in patients with suspected coronary heart disease: a prospective cohort study.

ABSTRACT: Trans fatty acids (TFAs) have been found to impair flow mediated vasodilation and nitric oxide (NO) production. We sought to examine if serum TFA levels are associated with plasma levels of the NO inhibitor asymmetric dimethylarginine (ADMA) and if possible relationships between serum TFA and cardiovascular morbidity or mortality are mediated or modified by plasma ADMA levels.The cohort included patients who underwent coronary angiography for suspected coronary heart disease in 2000-2001. Serum trans 16:1n7 and trans 18:1 isomers were determined by gas liquid chromatography and the summation of these two TFAs is reported as TFA (percentage by weight (wt%) or concentration). Associations between TFAs and ADMA were estimated by calculating the Spearman's rank correlation coefficient (?), and risk associations with AMI, cardiovascular death and all-cause mortality across quartiles of TFAs (wt% or concentration) were explored by Cox modeling.A total of 1364 patients (75 % men) with median (25(th),75(th) percentile) age 61 (54, 69) years, serum TFA 0.46 (0.36, 0.56) wt% and plasma ADMA 0.59 (0.50, 0.70) ?mol/L were studied. Serum TFA levels (? = 0.21, p < 0.001), trans 16:1n7 (? = 0.22, p < 0.001) and trans 18:1 (? = 0.20, p < 0.001) levels were significantly correlated with plasma ADMA levels. During the median (25(th),75(th) percentile) follow-up time of 5.8 (4.5, 6.4) years, 129 (9.5 %) patients experienced an AMI, 124 (9.1 %) died, whereof 66 (53 %) due to cardiovascular causes. After multivariate adjustments no significant associations between serum TFA levels (wt% or concentration) and incident AMI, CV death and all-cause mortality were observed. Similar results were obtained when repeating the analyses with trans 16:1n7 and trans 18:1 individually. Plasma ADMA levels did not significantly modify the associations between TFA levels and outcomes.Serum TFA levels were positively correlated with plasma ADMA levels. After multivariate adjustments, TFAs were not associated with incident AMI or mortality, and associations were not influenced by ADMA.Clinicaltrials.gov Identifier: NCT00354081.

SUBMITTER: Borgeraas H

PROVIDER: S-EPMC4769542 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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Serum trans fatty acids, asymmetric dimethylarginine and risk of acute myocardial infarction and mortality in patients with suspected coronary heart disease: a prospective cohort study.

Borgeraas Heidi H Hertel Jens Kristoffer JK Seifert Reinhard R Berge Rolf K RK Bohov Pavol P Ueland Per Magne PM Nygård Ottar O Hjelmesæth Jøran J

Lipids in health and disease 20160227

<h4>Background</h4>Trans fatty acids (TFAs) have been found to impair flow mediated vasodilation and nitric oxide (NO) production. We sought to examine if serum TFA levels are associated with plasma levels of the NO inhibitor asymmetric dimethylarginine (ADMA) and if possible relationships between serum TFA and cardiovascular morbidity or mortality are mediated or modified by plasma ADMA levels.<h4>Methods</h4>The cohort included patients who underwent coronary angiography for suspected coronary ...[more]

PMID: 26920731

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Project description:BACKGROUND:Telomeres are non-coding sequences at the end of eukaryote chromosomes, which in complex with associated proteins serve to protect subtelomeric DNA. Telomeres shorten with each cell division, are regarded as a biomarker for aging and have also been suggested to play a role in atherosclerosis and cardiovascular disease (CVD). The aim of the present study was to explore the associations between leukocyte telomere length and serum polyunsaturated fatty acids, diet, cardiovascular risk factors and features of myocardial infarction (MI) in elderly patients. METHODS:The material is based upon the first 299 included patients in the OMEMI trial, where patients aged 70-82?years of age are randomized to receive omega-3 supplements or corn oil (placebo) after MI. Patients were included 2-8?weeks after the index MI. DNA was extracted from whole blood, and leukocyte telomere length (LTL) was analyzed by qPCR and reported as a number relative to a reference gene. Serum long chain polyunsaturated fatty acid (LCPUFA) content was analyzed by gas chromatography. Diet was evaluated with the validated SmartDiet food frequency questionnaire. Medical records, patient interviews and clinical examination provided previous medical history and anthropometric data. Non-parametric statistical tests were used. RESULTS:Median (25, 75 percentile) LTL was 0.55 (0.42, 0.72). Patients had a median age of 75?years, 70.2% were male and 45.2% used omega-3 supplements. There was a weak, but significant correlation between LTL and linoleic acid (r =?0.139, p =?0.017), but not with other LCPUFAs. There was a trend towards longer telomeres with a healthier diet, but this did not reach statistical significance (p =?0.073). No associations were found between LTL and CVD risk factors or features of MI. CONCLUSIONS:In our population of elderly with a recent myocardial infarction LTL was associated with linoleic acid concentrations, but not with other LCPUFAs. Patients with a healthy diet tended to have longer telomeres. The limited associations may be due to age and the narrow age-span in our population. Further studies, designed to detect longitudinal changes should be performed to explore the role of telomeres in cardiovascular aging. TRIAL REGISTRATION:Clinical trials no. NCT01841944, registration date April 29, 2013.

Project description:Unrecognized myocardial infarction (UMI) is known to constitute a substantial portion of potentially lethal coronary heart disease. However, the diagnosis of UMI is based on the appearance of incidental Q-waves on 12-lead electrocardiography. Thus, the syndrome of non-Q-wave UMI has not been investigated. Delayed-enhancement cardiovascular magnetic resonance (DE-CMR) can identify MI, even when small, subendocardial, or without associated Q-waves. The aim of this study was to investigate the prevalence and prognosis associated with non-Q-wave UMI identified by DE-CMR.We conducted a prospective study of 185 patients with suspected coronary disease and without history of clinical myocardial infarction who were scheduled for invasive coronary angiography. Q-wave UMI was determined by electrocardiography (Minnesota Code). Non-Q-wave UMI was identified by DE-CMR in the absence of electrocardiographic Q-waves. Patients were followed to determine the prognostic significance of non-Q-wave UMI. The primary endpoint was all-cause mortality. The prevalence of non-Q-wave UMI was 27% (50/185), compared with 8% (15/185) for Q-wave UMI. Patients with non-Q-wave UMI were older, were more likely to have diabetes, and had higher Framingham risk than those without MI, but were similar to those with Q-wave UMI. Infarct size in non-Q-wave UMI was modest (8%+/-7% of left ventricular mass), and left ventricular ejection fraction (LVEF) by cine-CMR was usually preserved (52%+/-18%). The prevalence of non-Q-wave UMI increased with the extent and severity of coronary disease on angiography (p<0.0001 for both). Over 2.2 y (interquartile range 1.8-2.7), 16 deaths occurred: 13 in non-Q-wave UMI patients (26%), one in Q-wave UMI (7%), and two in patients without MI (2%). Multivariable analysis including New York Heart Association class and LVEF demonstrated that non-Q-wave UMI was an independent predictor of all-cause mortality (hazard ratio [HR] 11.4, 95% confidence interval [CI] 2.5-51.1) and cardiac mortality (HR 17.4, 95% CI 2.2-137.4).In patients with suspected coronary disease, the prevalence of non-Q-wave UMI is more than 3-fold higher than Q-wave UMI. The presence of non-Q-wave UMI predicts subsequent mortality, and is incremental to LVEF.Clinicaltrials.gov NCT00493168.

Dataset Information

Serum trans fatty acids, asymmetric dimethylarginine and risk of acute myocardial infarction and mortality in patients with suspected coronary heart disease: a prospective cohort study.

Publications

Serum trans fatty acids, asymmetric dimethylarginine and risk of acute myocardial infarction and mortality in patients with suspected coronary heart disease: a prospective cohort study.

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