Low Docosahexaenoic Acid, Dihomo-Gamma-Linolenic Acid, and Arachidonic Acid Levels Associated with Long-Term Mortality in Patients with Acute Decompensated Heart Failure in Different Nutritional Statuses
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Blood Sampling
2.3. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. PUFA Levels and GNRI in the Survivor and Nonsurvivor Groups
3.3. Cumulative Event-Free Survival Rates Based on PUFA Levels and GNRI
3.4. Effects of PUFA Levels on Event-Free Survival Independent of GNRI
3.5. Univariate and Multivariate Analyses of Parameters Contributing to Long-Term Mortality
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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All (n = 214) | Survivor Group (n = 152) | Nonsurvivor Group (n = 62) | p-Value * | |
---|---|---|---|---|
Age (years) | 73 (64–82) | 72 (61–81) | 74 (69–82) | 0.03 |
Male (n, %) | 115 (53.7) | 77 (50.7) | 38 (61.3) | NS |
Body mass index (kg/m2) | 22.9 (20.4–25.7) | 23.4 (21.1–26.7) | 21.1 (19.5–23.4) | <0.01 |
Systolic blood pressure (mmHg) | 130 (110–149) | 135 (115–155) | 115 (94–135) | <0.01 |
Diastolic blood pressure (mmHg) | 77 (62–90) | 80 (68–96) | 65 (56–77) | <0.01 |
Heart rate (per min) | 93 (74–112) | 97 (75–118) | 87 (71–101) | 0.01 |
Left ventricular ejection fraction (%) | 35 (25–49) | 38 (26–51) | 32 (20–45) | NS |
Diabetes mellitus (n, %) | 89 (41.6) | 61 (40.1) | 28 (45.2) | NS |
Dyslipidemia (n, %) | 143 (66.8) | 111 (73.0) | 32 (51.6) | <0.01 |
Hypertension (n, %) | 142 (66.4) | 100 (65.8) | 42 (67.7) | NS |
Smoking (current smoker) (n, %) | 25 (11.7) | 22 (14.6) | 3 (4.8) | NS |
Atrial fibrillation (n, %) | 91 (42.5) | 67 (44.1) | 24 (38.7) | NS |
Ischemic heart disease (n, %) | 85 (39.7) | 56 (36.8) | 29 (46.8) | NS |
Laboratory data | ||||
Total cholesterol (mg/dL) | 153 (128–178) | 156 (132–186) | 140 (116–161) | <0.01 |
Triglycerides (mg/dL) | 77 (56–108) | 80 (58–109) | 72 (49–105) | NS |
HDL-C (mg/dL) | 38 (33–49) | 38 (33–50) | 38 (32–46) | NS |
LDL-C (mg/dL) | 92 (75–113) | 100 (79–117) | 82 (69–105) | <0.01 |
Creatinine (mg/dL) | 0.94 (0.72–1.31) | 0.87 (0.67–1.22) | 1.25 (0.94–1.80) | <0.01 |
HbA1c (%) | 6.0 (5.5–6.7) | 6.0 (5.5–6.8) | 6.0 (5.6–6.6) | NS |
Total protein (g/dL) | 6.4 (6.0–6.7) | 6.4 (6.1–6.7) | 6.3 (5.9–6.9) | NS |
Albumin (g/dL) | 3.4 (3.0–3.6) | 3.5 (3.1–3.8) | 3.2 (2.9–3.4) | <0.01 |
Cholinesterase (U/L) | 183 (138–244) | 210 (154–264) | 158 (105–183) | <0.01 |
Brain natriuretic peptide (pg/mL) | 800 (445–1610) | 627 (372–1206) | 1495 (660–2246) | <0.01 |
EPA (μg/mL) | 40.6 (28.7–61.6) | 42.6 (31.2–62.6) | 34.4 (26.1–50.9) | 0.04 |
DHA (μg/mL) | 109.6 (88.8–138.2) | 112.4 (93.9–140.6) | 104.3 (81.1–128.2) | 0.04 |
DGLA (μg/mL) | 21.8 (17.4–29.5) | 23.0 (18.5–32.0) | 19.1 (14.7–22.9) | <0.01 |
AA (μg/mL) | 145.7 (117.0–182.4) | 160.2 (122.6–190.2) | 137.2 (107.2–158.1) | <0.01 |
GNRI | 90.8 (84.5–94.8) | 92.3 (85.6–96.6) | 87.9 (81.4–90.2) | <0.01 |
Medication | ||||
Diuretics (n, %) | 115 (54.5) | 66 (44.0) | 49 (80.3) | <0.01 |
Antiplatelets (n, %) | 77 (36.5) | 44 (29.3) | 33 (54.1) | <0.01 |
Anticoagulants (n, %) | 75 (35.5) | 47 (31.3) | 28 (45.9) | NS |
ACE-I/ARBs (n, %) | 107 (50.7) | 72 (48.0) | 35 (57.4) | NS |
β-blockers (n, %) | 96 (45.5) | 62 (41.3) | 34 (55.7) | NS |
Calcium channel blockers (n, %) | 59 (28.0) | 40 (26.7) | 19 (31.2) | NS |
Inotropic agents (n, %) | 34 (16.1) | 16 (10.7) | 18 (29.5) | <0.01 |
Statins (n, %) | 52 (24.6) | 37 (24.7) | 15 (24.6) | NS |
Oral hypoglycemic agents (n, %) | 43 (20.3) | 32 (21.2) | 11 (18.0) | NS |
Insulin (n, %) | 23 (10.8) | 18 (11.9) | 5 (8.2) | NS |
Univariate | Multivariate (EPA) | Multivariate (DHA) | Multivariate (DGLA) | Multivariate (AA) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
HR | 95% CI | p | HR | 95% CI | P | HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | |
Age, 1 year increase | 1.03 | 1.01–1.06 | <0.01 | 1.04 | 1.01–1.07 | 0.01 | 1.05 | 1.02–1.09 | <0.01 | 1.04 | 1.00–1.07 | 0.03 | 1.04 | 1.01–1.08 | <0.01 |
Male | 1.42 | 0.86–2.39 | NS | 0.88 | 0.44–1.74 | NS | 0.74 | 0.37–1.44 | NS | 0.85 | 0.44–1.66 | NS | 0.83 | 0.42–1.64 | NS |
Body mass index, 1 kg/m2 increase | 0.87 | 0.81–0.93 | <0.01 | 0.95 | 0.87–1.03 | NS | 0.96 | 0.87–1.04 | NS | 0.95 | 0.86–1.03 | NS | 0.94 | 0.86–1.03 | NS |
Diabetes mellitus | 1.13 | 0.68–1.86 | NS | 0.87 | 0.43–1.71 | NS | 0.87 | 0.44–1.72 | NS | 0.72 | 0.35–1.46 | NS | 0.85 | 0.42–1.68 | NS |
Dyslipidemia | 0.43 | 0.26–0.71 | <0.01 | 0.39 | 0.20–0.76 | <0.01 | 0.43 | 0.22–0.82 | 0.01 | 0.51 | 0.26–0.98 | 0.04 | 0.46 | 0.24–0.89 | 0.02 |
Hypertension | 1.08 | 0.64–1.88 | NS | 0.78 | 0.41–1.54 | NS | 0.84 | 0.44–1.70 | NS | 0.76 | 0.39–1.53 | NS | 0.68 | 0.35–1.36 | NS |
Smoking (current smoker) | 0.31 | 0.08–0.84 | 0.02 | 0.49 | 0.09–1.82 | NS | 0.44 | 0.07–1.78 | NS | 0.40 | 0.07–1.64 | NS | 0.38 | 0.07–1.47 | NS |
Creatinine, 0.1 mg/dL increase | 1.09 | 1.06–1.13 | <0.01 | 1.07 | 1.02–1.12 | <0.01 | 1.09 | 1.04–1.14 | <0.01 | 1.10 | 1.05–1.16 | <0.01 | 1.11 | 1.05–1.17 | <0.01 |
LVEF, 1% increase | 0.99 | 0.98–1.01 | NS | 1.00 | 0.98–1.02 | NS | 0.99 | 0.97–1.01 | NS | 0.99 | 0.98–1.01 | NS | 0.99 | 0.97–1.01 | NS |
GNRI, increase by 1 | 0.94 | 0.92–0.97 | <0.01 | 0.95 | 0.91–0.99 | 0.02 | 0.94 | 0.91–0.98 | <0.01 | 0.94 | 0.90–0.98 | <0.01 | 0.94 | 0.91–0.98 | <0.01 |
EPA, 10 μg/mL increase | 0.90 | 0.79–1.01 | NS | 0.88 | 0.73–1.03 | NS | |||||||||
DHA, 10 μg/mL increase | 0.91 | 0.84–0.99 | 0.02 | 0.87 | 0.78–0.96 | <0.01 | |||||||||
DGLA, 10 μg/mL increase | 0.55 | 0.37–0.76 | <0.01 | 0.54 | 0.34–0.80 | <0.01 | |||||||||
AA, 10 μg/mL increase | 0.91 | 0.85–0.96 | <0.01 | 0.92 | 0.86–0.98 | <0.01 |
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Ouchi, S.; Miyazaki, T.; Shimada, K.; Sugita, Y.; Shimizu, M.; Murata, A.; Kato, T.; Aikawa, T.; Suda, S.; Shiozawa, T.; et al. Low Docosahexaenoic Acid, Dihomo-Gamma-Linolenic Acid, and Arachidonic Acid Levels Associated with Long-Term Mortality in Patients with Acute Decompensated Heart Failure in Different Nutritional Statuses. Nutrients 2017, 9, 956. https://doi.org/10.3390/nu9090956
Ouchi S, Miyazaki T, Shimada K, Sugita Y, Shimizu M, Murata A, Kato T, Aikawa T, Suda S, Shiozawa T, et al. Low Docosahexaenoic Acid, Dihomo-Gamma-Linolenic Acid, and Arachidonic Acid Levels Associated with Long-Term Mortality in Patients with Acute Decompensated Heart Failure in Different Nutritional Statuses. Nutrients. 2017; 9(9):956. https://doi.org/10.3390/nu9090956
Chicago/Turabian StyleOuchi, Shohei, Tetsuro Miyazaki, Kazunori Shimada, Yurina Sugita, Megumi Shimizu, Azusa Murata, Takao Kato, Tatsuro Aikawa, Shoko Suda, Tomoyuki Shiozawa, and et al. 2017. "Low Docosahexaenoic Acid, Dihomo-Gamma-Linolenic Acid, and Arachidonic Acid Levels Associated with Long-Term Mortality in Patients with Acute Decompensated Heart Failure in Different Nutritional Statuses" Nutrients 9, no. 9: 956. https://doi.org/10.3390/nu9090956