Low Plasma Proportion of Omega 3-Polyunsaturated Fatty Acids Predicts Poor Outcome in Acute Non-Cardiogenic Ischemic Stroke Patients
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background and Purpose Alterations in blood fatty acid (FA) composition are associated with cardiovascular diseases. We investigated whether plasma FA composition was related to stroke severity and functional outcome in acute ischemic stroke patients. Methods We prospectively enrolled 156 patients with first-episode cerebral infarction, within 7 days of symptom onset. The proportion of FAs was analyzed using gas chromatography, and the summation of the omega-3 polyunsaturated fatty acids (ω3-PUFA), 18:3 ω3 α-linolenic acid, 20:3 ω3 eicosatrienoic acid, 20:5 ω3 eicosapentaenoic acid (EPA), and 22:6 ω3 docosahexaenoic acid (DHA) was reported as Σω3-PUFAs. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score on admission. Poor functional outcome was defined by modified Rankin scale (mRS) ≥3 at three months after the index stroke. Results Lower proportions of EPA (β=-0.751), DHA (β=-0.610), and Σω3-PUFAs (β=-0.462) were independently associated with higher NIHSS score, after adjusting for stroke subtype, hemoglobin, high density lipoprotein, high sensitivity C-reactive protein, fasting glucose, 16:0 palmitic acid, and Σsaturated fatty acids. Moreover, a lower proportion of DHA (odds ratio [OR]: 0.20, 95% confidence interval [CI]: 0.04-0.88), and Σω3-PUFAs (OR: 0.22, 95% CI: 0.05-0.84) showed an independent relationship with poor functional outcome after adjusting for age, sex, smoking status, NIHSS score, stroke subtype, and 16:0 palmitic acid. Conclusions Our results demonstrate that ω3-PUFAs correlated with stroke severity on admission and functional outcomes at 3 months. ω3-PUFAs are potential blood biomarkers for prognosis of acute non-cardiogenic ischemic stroke patients.
Abstract
Background and Purpose Alterations in blood fatty acid (FA) composition are associated with cardiovascular diseases. We investigated whether plasma FA composition was related to stroke severity and functional outcome in acute ischemic stroke patients. Methods We prospectively enrolled 156 patients with first-episode cerebral infarction, within 7 days of symptom onset. The proportion of FAs was analyzed using gas chromatography, and the summation of the omega-3 polyunsaturated fatty acids (ω3-PUFA), 18:3 ω3 α-linolenic acid, 20:3 ω3 eicosatrienoic acid, 20:5 ω3 eicosapentaenoic acid (EPA), and 22:6 ω3 docosahexaenoic acid (DHA) was reported as Σω3-PUFAs. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score on admission. Poor functional outcome was defined by modified Rankin scale (mRS) ≥3 at three months after the index stroke. Results Lower proportions of EPA (β=-0.751), DHA (β=-0.610), and Σω3-PUFAs (β=-0.462) were independently associated with higher NIHSS score, after adjusting for stroke subtype, hemoglobin, high density lipoprotein, high sensitivity C-reactive protein, fasting glucose, 16:0 palmitic acid, and Σsaturated fatty acids. Moreover, a lower proportion of DHA (odds ratio [OR]: 0.20, 95% confidence interval [CI]: 0.04-0.88), and Σω3-PUFAs (OR: 0.22, 95% CI: 0.05-0.84) showed an independent relationship with poor functional outcome after adjusting for age, sex, smoking status, NIHSS score, stroke subtype, and 16:0 palmitic acid. Conclusions Our results demonstrate that ω3-PUFAs correlated with stroke severity on admission and functional outcomes at 3 months. ω3-PUFAs are potential blood biomarkers for prognosis of acute non-cardiogenic ischemic stroke patients.
참고문헌 (35)
- Calder PC, "The role of marine omega-3 (n-3) fatty acids in inflammatory processes, atherosclerosis and plaque stability", Mol Nutr Food Res, 56, pp.1073~1080 (2012)
- Calder PC, "n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases", Am J Clin Nutr, 83(Suppl 6), pp.1505S~1519S (2006)
- Schmidt EB, "Cod liver oil inhibits neutrophil and monocyte chemotaxis in healthy males", Atherosclerosis, 77, pp.53~57 (1989)
- Weber C, "Docosahexaenoic acid selectively attenuates induction of vascular cell adhesion molecule-1 and subsequent monocytic cell adhesion to human endothelial cells stimulated by tumor necrosis factor-alpha", Arterioscler Thromb Vasc Biol, 15, pp.622~628 (1995)
- Montonen J, "Fish consumption and the incidence of cerebrovascular disease", Br J Nutr, 102, pp.750~756 (2009)
- Tanaka K, "Reduction in the recurrence of stroke by eicosapentaenoic acid for hypercholesterolemic patients: subanalysis of the JELIS trial", Stroke, 39, pp.2052~2058 (2008)
- "Atheroscler Suppl", 2013, 243~251
- Marangoni F, "Omega-6 and omega-3 polyunsaturated fatty acid levels are reduced in whole blood of Italian patients with a recent myocardial infarction: the AGE-IM study", Atherosclerosis, 232, pp.334~338 (2014)
- Park Y, "Low level of n-3 polyunsaturated fatty acids in erythrocytes is a risk factor for both acute ischemic and hemorrhagic stroke in Koreans", Nutr Res, 29, pp.825~830 (2009)
- Iso H, "Linoleic acid, other fatty acids, and the risk of stroke", Stroke, 33, pp.2086~2093 (2002)
- Kim YJ, "Plasma phospholipid fatty acid composition in ischemic stroke: importance of docosahexaenoic acid in the risk for intracranial atherosclerotic stenosis", Atherosclerosis, 225, pp.418~424 (2012)
- Enns JE, "The impact of omega-3 polyunsaturated fatty acid supplementation on the incidence of cardiovascular events and complications in peripheral arterial disease: a systematic review and meta-analysis", BMC Cardiovasc Disord, 14 (2014)
- 김대현, "Organized Comprehensive Stroke Center is Associated with Reduced Mortality: Analysis of Consecutive Patients in a Single Hospital", 대한뇌졸중학회지, 15(1), pp.57~63 (2013), 대한뇌졸중학회[DOI]
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment", Stroke, 24, pp.35~41 (1993)
- "Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators", N Engl J Med, 325, pp.445~453 (1991)
- "Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators. Design, progress and challenges of a double-blind trial of warfarin versus aspirin for symptomatic intracranial arterial stenosis", Neuroepidemiology, 22, pp.106~117 (2003)
- 오미선, "Validity and Reliability of a Korean Version of the National Institutes of Health Stroke Scale", Journal of Clinical Neurology, 8(3), pp.177~183 (2012), 대한신경과학회[DOI]
- Folch J, "A simple method for the isolation and purification of total lipides from animal tissues", J Biol Chem, 226, pp.497~509 (1957)
- Lepage G, "Direct transesterification of all classes of lipids in a one-step reaction", J Lipid Res, 27, pp.114~120 (1986)
- Do HJ, "Relationship between the estimates of desaturase activities and cardiometabolic phenotypes in Koreans", J Clin Biochem Nutr, 49, pp.131~135 (2011)
- Kim YJ, "Plasma levels of apolipoprotein E and risk of intracranial artery stenosis in acute ischemic stroke patients", Ann Nutr Metab, 62, pp.26~31 (2013)
- Eady TN, "Acute treatment with docosahexaenoic acid complexed to albumin reduces injury after a permanent focal cerebral ischemia in rats", PloS One, 8, pp.e77237~ (2013)
- Chang CY, "Docosahexaenoic acid reduces cellular inflammatory response following permanent focal cerebral ischemia in rats", J Nutr Biochem, 24, pp.2127~2137 (2013)
- Suda S, "Low serum n-3 polyunsaturated fatty acid", n-6 polyunsaturated fatty acid ratio predicts neurological deterioration in Japanese patients with acute ischemic stroke, 2013, pp.36, 388~393
- Mozaffarian D, "Plasma phospholipid long-chain omega-3 fatty acids and total and cause-specific mortality in older adults: a cohort study", Ann Intern Med, 158, pp.515~525 (2013)
- Dessì M, "Atherosclerosis, dyslipidemia, and inflammation: the significant role of polyunsaturated fatty acids", ISRN Inflamm, 2013, pp.1918~1923 (2013)
- Nagai M, "Visit-to-visit blood pressure variability, silent cerebral injury, and risk of stroke", Am J Hypertens, 26, pp.1369~1376 (2013)
- Serhan CN, "Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators", Nat Rev Immunol, 8, pp.349~361 (2008)
- Serhan CN, "Resolvins: a family of bioactive products of omega-3 fatty acid transformation circuits initiated by aspirin treatment that counter proinflammation signals", J Exp Med, 196, pp.1025~1037 (2002)
- Bailey EL, "Pathology of lacunar ischemic stroke in humans--a systematic review", Brain Pathol, 22, pp.583~591 (2012)
- Song TJ, "The distribution of cerebral microbleeds determines their association with arterial stiffness in non-cardioembolic acute stroke patients", Eur J Neurol, 21, pp.463~469 (2014)
- Lei C, "Risk factors and clinical outcomes associated with intracranial and extracranial atherosclerotic stenosis acute ischemic stroke", J Stroke Cerebrovasc Dis, 23, pp.1112~1117 (2014)
- Thies F, "Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controlled trial", Lancet, 361, pp.477~485 (2003)
- Cawood AL, "Eicosapentaenoic acid (EPA) from highly concentrated n-3 fatty acid ethyl esters is incorporated into advanced atherosclerotic plaques and higher plaque EPA is associated with decreased plaque inflammation and increased stability", Atherosclerosis, 212, pp.252~259 (2010)
- Wang J, "Omega-3 polyunsaturated fatty acids enhance cerebral angiogenesis and provide long-term protection after stroke", Neurobiol Dis, 68, pp.91~103 (2014)