Red blood cell fatty acid patterns from 7 countries: Focus on the Omega-3 index.

Red blood cell (RBC) fatty acid (FA) patterns are becoming recognized as long-term biomarkers of tissue FA composition, but different analytical methods have complicated inter-study and international comparisons. Here we report RBC FA data, with a focus on the Omega-3 Index (EPA + DHA in% of total FAs in RBC), from samples of seven countries (USA, Canada, Italy, Spain, Germany, South Korea, and Japan) including 167,347 individuals (93% of all samples were from the US). FA data were generated by a uniform methodology from a variety of interventional and observational studies and from clinical laboratories. The cohorts differed in size, demographics, health status, and year of collection. Only the Canadian cohort was a formal, representative population-based survey. The mean Omega-3 Index of each country was categorized as desirable (>8%), moderate (>6% to 8%), low (>4% to 6%), or very low (≤4%). Only cohorts from Alaska (treated separately from the US), South Korea and Japan showed a desirable Omega-3 Index. The Spanish cohort had a moderate Omega-3 Index, while cohorts from the US, Canada, Italy, and Germany were all classified as low. This study is limited by the use of cohorts of convenience and small sample sizes in some countries. Countries undertaking national health status studies should utilize a uniform method to measure Omega-3 FA levels.

G-CSF for Extensive STEMI.

RATIONALE: In the exploratory Phase II STEM-AMI (Stem Cells Mobilization in Acute Myocardial Infarction) trial, we reported that early administration of G-CSF (granulocyte colony-stimulating factor), in patients with anterior ST-segment-elevation myocardial infarction and left ventricular (LV) dysfunction after successful percutaneous coronary intervention, had the potential to significantly attenuate LV adverse remodeling in the long-term. OBJECTIVE: The STEM-AMI OUTCOME CMR (Stem Cells Mobilization in Acute Myocardial Infarction Outcome Cardiac Magnetic Resonance) Substudy was adequately powered to evaluate, in a population showing LV ejection fraction ≤45% after percutaneous coronary intervention for extensive ST-segment-elevation myocardial infarction, the effects of early administration of G-CSF in terms of LV remodeling and function, infarct size assessed by late gadolinium enhancement, and myocardial strain. METHODS AND RESULTS: Within the Italian, multicenter, prospective, randomized, Phase III STEM-AMI OUTCOME trial, 161 ST-segment-elevation myocardial infarction patients were enrolled in the CMR Substudy and assigned to standard of care (SOC) plus G-CSF or SOC alone. In 119 patients (61 G-CSF and 58 SOC, respectively), CMR was available at baseline and 6-month follow-up. Paired imaging data were independently analyzed by 2 blinded experts in a core CMR lab. The 2 groups were similar for clinical characteristics, cardiovascular risk factors, and pharmacological treatment, except for a trend towards a larger infarct size and longer symptom-to-balloon time in G-CSF patients. ANCOVA showed that the improvement of LV ejection fraction from baseline to 6 months was 5.1% higher in G-CSF patients versus SOC (P=0.01); concurrently, there was a significant between-group difference of 6.7 mL/m2 in the change of indexed LV end-systolic volume in favor of G-CSF group (P=0.02). Indexed late gadolinium enhancement significantly decreased in G-CSF group only (P=0.04). Moreover, over time improvement of global longitudinal strain was 2.4% higher in G-CSF patients versus SOC (P=0.04). Global circumferential strain significantly improved in G-CSF group only (P=0.006). CONCLUSIONS: Early administration of G-CSF exerted a beneficial effect on top of SOC in patients with LV dysfunction after extensive ST-segment-elevation myocardial infarction in terms of global systolic function, adverse remodeling, scar size, and myocardial strain. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01969890.

Importancia de los ácidos grasos omega-3 en la prevención secundaria del infarto agudo de miocardio / Importance of omega-3 fatty acids in the secondary prevention of acute myocardial infarction

Desde la década de los sesenta, las simples observaciones de los hábitos alimentarios indicaban que los ácidos grasos poliinsaturados (AGPI) omega-3 podían ser beneficiosos para la prevención cardiovascular, tanto en los modelos animales como humanos. El efecto más evidente y directo parecía ser el antiarrítmico, al estabilizar la electrofisiología cardiaca. Sin embargo, con posterioridad se han investigado otros muchos efectos que han revelado otros posibles, y múltiples mecanismos de acción sobre diferentes objetivos celulares. De hecho, se ha demostrado la capacidad de estas moléculas para modular muchos de los procesos celulares y tisulares, como la inflamación, la proliferación celular, la migración, la apoptosis, etc. Por consiguiente, se plantearon diversas hipótesis para explicar los resultados observados y se diseñaron más estudios preclínicos y clínicos al respecto. En la actualidad disponemos de una gran cantidad de datos (epidemiológicos, experimentales y de ensayos clínicos) que han ido proporcionando gradualmente la base racional para el uso de estos compuestos en las enfermedades cardiovasculares, sobre todo en la prevención secundaria. Esta revisión pretende resumir las bases principales del conocimiento sobre los efectos de los AGPI omega-3, desde las observaciones epidemiológicas a los resultados de los ensayos clínicos, a través de los datos experimentales. Aunque ya hay una recomendación en las guías internacionales para el uso de los AGPI omega-3, aún se necesitan más investigaciones sobre su perfil de riesgo/beneficio y sus mecanismos de acción en diversos trastornos clínicos, como lo demuestra la existencia de muchos estudios clínicos en curso que aportarán nuevos datos en los próximos años (AU)

Since the 1970s, general observations of dietary habits in both animal models and humans have suggested that omega-3 polyunsaturated fatty acids might be beneficial in preventing cardiovascular disease. Their most apparent and direct action appears to be their antiarrhythmic effect, which involves the stabilization of cardiac electrophysiological activity. However, subsequent investigations into other actions have revealed that there may be numerous mechanisms of action affecting multiple cellular targets. In fact, it has been shown that these molecules are able to modulate many cellular and tissular processes, such as inflammation, and cell proliferation, migration and apoptosis. Consequently, several hypothesis have been proposed to explain these observations, with the result that better targeted preclinical and clinical studies have been designed. Today, a large body of evidence, from epidemiological, laboratory and clinical studies, is gradually expanding the rational basis for using these compounds in the treatment of cardiovascular disease, particularly for secondary prevention. The aim of this review was to summarize the range of findings that underlies our understanding of the effects of omega-3 polyunsaturated fatty acids, from epidemiological observations to the results of clinical trials, and including laboratory findings. Although recommendations on the use of these fatty acids are already included in international guidelines, it is important that their risk–benefit profile and mechanisms of action in various clinical conditions continue to be investigated, as is being done in many ongoing clinical studies, which should provide new data in coming years (AU)