1. Circulating Long-Chain ω-3 Fatty Acids and Incidence of Congestive Heart Failure in Older Adults: The Cardiovascular Health Study Funded by: National Institutes of Health Dariush Mozaffarian, MD, DrPH; et. al. Annals of Internal Medicine. 2011;155:160-170. Julianna L. Murphy Pharm.D. Candidate Preceptor: Ali Rahimi, MD, FACP-AGSF August 19, 2011

2. Objective To determine whether plasma phospholipid concentrations of long-chain ω-3 fatty acids, including eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA), were associated with incident CHF.

3. ω-3 Fatty Acids Essential fatty acids Reduce inflammation May reduce risk for chronic diseases, including heart disease Have also been used for: ◦ Dyslipidemia ◦ Hypertension ◦ Diabetes mellitus

4. Study Design and Patient Population Multicenter, prospective cohort Conducted over a 13-year period 5,888 ambulatory, non-institutionalized adults recruited in 4 U.S. communities 2,735 participants analyzed All data collected from 1992 to 1993 visit and blood sample Standardized procedure for CHF confirmation

5. Participant Criteria Age 65+ years Within the 4 recruitment communities Exclusions: ◦ Diagnosed CHF at time of enrollment ◦ Presence of coronary heart disease or other serious cardiovascular illness

6. Measurements and Outcome Plasma phospholipid fatty acid concentrations measured in 1992 samples Relationships with incident CHF assessed using Cox proportional hazards models Other cardiovascular risk factors were similarly analyzed

7. Results Plasma EPA concentration inversely associated with CHF, with hazard ratio (HR) of 0.52 Lower risk trends also found with DPA (HR = 0.76) and total ω -3 fatty acid levels (HR = 0.70) DHA levels not found to be inversely associated with incident CHF

8. Results

9. Conclusion Higher levels of circulating ω -3 fatty acids are associated with a lower incidence of congestive heart failure in older adults

10. Comments Limitations ◦ Fatty acid concentrations measured only once ◦ Possible presence of additional confounders ◦ Study sample only from 4 communities in the United States ◦ Dietary recall performed once, at time of enrollment

11. Level of Evidence/Grade of Recommendation Level IIb Grade B