Comprehensive cardiac rehabilitation increases the serum EPA level and EPA/AA ratio in patients with acute myocardial infarction

The residual risk of cardiovascular events after statin therapy might be explained, in part, by low levels of serum n-3 Polyunsaturated Fatty Acids (PUFAs), especially Eicosapentaenoic Acid (EPA) and Docosahexiaenoic Acid (DHA). In addition, a recent study has shown that statin therapy reduces the serum n-3 PUFAs levels. Purpose: We investigated whether Comprehensive Cardiac Rehabilitation (CCR) affects the serum PUFA levels in patients with acute myocardial infarction (AMI). Methods: Fifty-six consecutive AMI patients who underwent optimal medical therapy, including statins and CCR (e.g., assessment of risk factors, dietary counseling, exercise training and smoking cessation intervention) were enrolled in this study. Patients taking EPA or DHA supplements were excluded from the study. We compared the data for all patients between the AMI onset and 9.5 months after the onset. Results: The serum LDL-cholesterol level decreased markedly (115.0±36.9 mg/dl to 82.3±25.6 mg/dl, p < 0.001), while the serum HDL-cholesterol level stayed constant (45.4±17.2 mg/dl to 43.5±12.0 mg/dl, p = 0.54). The serum EPA level increased significantly (45.6±20.2 μg/dl to 65.1±31.7 μg/dl, p = 0.004), whereas the serum DHA and arachidonic acid (AA) levels remained unchanged (133.7±40.8 μg/dl to 134.0±51.9 μg/dl, p = 0.98 and 171.0±45.7 μg/dl to 186.0±50.3 μg/dl, p = 0.19, respectively). These changes resulted in a significant elevation in the serum EPA/AA ratio (0.28±0.14 to 0.37±0.28, p = 0.03), but not in the DHA/AA ratio (0.81±0.27 to 0.74±0.28, p = 0.28). Conclusions: In AMI patients, CCR and optimal medical therapy without EPA or DHA supplementation increased the serum EPA level and EPA/AA ratio. Lifestyle modification with CCR might therefore cancel the negative effects of statins on the serum PUFAs levels.