Impact of the eicosapentaenoic acid to arachidonic acid ratio on plaque characteristics in statin-treated patients with coronary artery disease

Background: A low eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio is associated with an increased risk of cardiovascular events in patients with coronary artery disease (CAD).Objective: To clarify the impact of the EPA/AA ratio on the characteristics of non-culprit coronary plaques in statin-treated patients with CAD.Methods: A total of 370 consecutive stable coronary disease patients treated with statins, who un-derwent percutaneous coronary intervention for the culprit lesion and optical coherence tomography (OCT) imaging of the non-culprit plaque in a culprit vessel were included. The characteristics of non culprit plaques assessed using OCT were compared between the lower EPA/AA group (EPA/AA < 0.4, n = 255) and the higher EPA/AA group (EPA/AA >0.4, n = 115).Results: The prevalence of lipid-rich plaque (58.8 vs. 41.7%, p = 0.003) and plaque with macrophages (56.5 vs. 31.3%, p < 0.001) was significantly higher in the lower EPA/AA group than in the higher EPA/AA group. This association was observed even if the LDL-C level was < 100 mg/dL. The prevalence of thin-cap fibroatheroma was significantly higher in patients with lower EPA/AA and higher LDL-C ( >100 mg/dL) than in those with higher EPA/AA and lower LDL-C ( < 100 mg/dL) (odds ratio: 2.750, 95% confidence interval: 1.182-6.988, p = 0.024). An EPA/AA < 0.4 was independently associ-ated with a higher prevalence of lipid-rich plaque, plaque with macrophages, and cholesterol crystals.Conclusion: Lower EPA/AA ratio was associated with higher prevalence of vulnerable characteristics in non-culprit plaques. The present results suggest the importance of EPA/AA ratio on the secondary prevention of CAD.(c) 2022 National Lipid Association. Published by Elsevier Inc. All rights reserved.