Abstract Body (Do not enter title and authors here): Background: Peripheral artery disease (PAD), affects >200 million globally, is linked to reduced quality of life and increased cardiovascular mortality. Standard care emphasizes physical activity, but less is known about nutritional interventions. Studies indicate that eicosapentaenoic acid (EPA), an omega-3 fatty acid, may reduce the risk of atherosclerotic cardiovascular disease. However, its impact on cardiovascular mortality risk in PAD patients is unclear.
Purpose: Our primary goal was to assess the relationship between EPA consumption and cardiovascular mortality in patients with PAD. We further examined the relationship between EPA consumption, inflammation, and blood lipids.
Approach: We used data from the National Health and Nutrition Examination Survey (NHANES, 1999–2004). Adults with PAD (ankle-brachial index [ABI] ≤0.9) were included in the study; exclusion criteria were age <18 or missing dietary, mortality, or covariate data. EPA consumption was extracted from dietary recalls, and participants were categorized into those with or without any reported daily EPA consumption. Mortality data were obtained from the National Death Index through 2019. Covariates and secondary outcomes, including blood lipids and C-reactive protein (CRP), were collected via NHANES exams or self-report. Regression models were used for group comparisons, adjusted for age and sex. Cardiovascular mortality risk was estimated using Cox models adjusted for age, sex, prior cardiovascular disease, hypertension, diabetes, and relevant medications. Results are reported as regression coefficients or hazard ratios (HR) and 95% confidence intervals (CI).
Results: We analyzed 623 PAD patients (67.6±12.3 years, 58.1% female, ABI 0.77±0.13); 37.2% reported no daily EPA intake. Age, sex, ABI, and medication use were not different between groups. LDL was lower in EPA consumers (β -6.1 mg/dL, 95%CI: -10.0- -2.2, p=0.022); other cholesterol measures and CRP were not different. EPA intake was associated with reduced risk of cardiovascular mortality (HR 0.66, 95%CI: 0.62-0.70, p=0.001) over an average follow-up of 10.8 years. The adjusted model remained significant (p=0.003).
Conclusions: Daily intake of EPA is associated with reduced cardiovascular mortality risk in individuals with PAD. Further studies are needed to understand the physiological mechanisms underlying this relationship, and the clinical implications of this potential dietary intervention.