Background: A low eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio is a known risk for acute coronary\nsyndrome (ACS). However, the association between the docosahexaenoic acid (DHA) to AA ratio and ACS remains\nunclear. This study aimed to assess the association between the DHA/AA ratio and ACS by patient characteristics.\nMethods: We enrolled 1733 patients and evaluated the serum levels of polyunsaturated fatty acids in 5 cardiology\ndepartments in a metropolitan area of Japan. We assessed the relationship between the DHA/AA ratio (median\ncut-off value: 0.903) and ACS according to the following 10 subgroups: sex, age, diabetes mellitus, hypertension,\ndyslipidemia, smoking history, family history of ischemic heart disease, chronic kidney disease, obesity, and history\nof coronary revascularization.\nResults: Interaction tests in the 10 subgroup analyses revealed a significant difference for adjusted log odds ratios\nbetween male and females (p = 0.01), and those with and without hypertension (p = 0.06). Especially in the\nsubgroup based on sex difference, a high DHA/AA ratio was significantly associated with a low risk of ACS among\nmen (adjusted odds ratio = 0.389; 95 % confidence interval: 0.211ââ?¬â??0.716). In contrast, a reverse association was\nfound among women, although this was not statistically significant (adjusted odds ratio = 3.820; 95 % confidence\ninterval: 0.718ââ?¬â??20.325).\nConclusions: The association between the DHA/AA ratio and ACS differed by clinical characteristic. Notably,\npatients with a low DHA/AA ratio had a higher risk of ACS than those with a high DHA/AA ratio, and this was\nsignificant for men in particular.
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