Effect of serum fatty acid composition on coronary atherosclerosis in Japan

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Abstract

The serum lipid profiles of patient's with or without significant coronary stenosis diagnosed by coronary angiography and of control subjects were compared. The level of high-density-lipoprotein cholesterol and eicosapentaenoic acid were significantly lower in the patients with significant coronary stenosis than in the control subjects. It suggests that high-density-lipoprotein cholesterol and ω3 fatty acids may have a protective effect on the progress of coronary atherosclerosis. The frequency of eating dark-meat fish was positively associated with serum eicosapentaenoic acid and docosahexaenoic acid, ω3 fatty acids, and inversely associated with serum stearic acid and linoleic acid. The frequency of eating soybean products was positively associated with serum docosahexaenoic acid and inversely associated with serum linoleic acid. It is necessary to discuss a way to popularise a diet of dark-meat fish and soybean products as a means of preventing coronary heart disease.

Introduction

The adjusted death rate caused by coronary heart disease is quite low in Japan compared to Europe and North America. In Japan, the death rate of those 30–69 years old was 38 men and 13 women per 100 000 population in 1985. These rates are about 1/6 of the rate for men and 1/5 for women in the US [1]. It is reported that Japanese risk factors for coronary heart disease, other than food intake, are the same as for Europeans and Americans [2]. The Japanese average total serum cholesterol concentration is low because Japanese have lower fat intake than Europeans and Americans, resulting in a lower death rate due to coronary heart disease. In addition, the ingestion of a relatively large amount of fish is also thought to be a reason for the low prevalence of coronary heart disease 3, 4, 5, 6, 7.

Unfortunately, the Japanese lifestyle, especially eating habits, is now changing [8]. Most older people maintain a traditional Japanese diet; centred rice, soybean products and fish, in contrast to younger people who are changing to western style diets in the study district [9]. Even older people, however, display a wide range of dietary habits in keeping with their lifestyle. The individual differences of the concentrations of total serum cholesterol and the ratio of serum ω3/ω6 fatty acids are gradually growing because of the variety of fat intake by individuals.

Coronary heart disease is thought to be caused by three factors: coronary atherosclerosis, coronary thrombus and coronary spasm. Coronary atherosclerosis plays an especially important role. Many factors lead to the development and progress of coronary atherosclerosis [10]. Four risk factors for coronary heart disease — ageing, hypercholesterolemia, hypertension and smoking — have been identified as the most important by cohort studies 11, 12, 13. Diabetes mellitus is also a major risk factor for coronary heart disease [14].

Dyerberg et al. [15]showed that fish consumption appeared to prevent coronary heart disease. Fish oil contains abundant ω3 polyunsaturated fatty acids. Since then, many studies reported a positive relationship between the intake of ω3 fatty acids and the prevention of the development and recurrence of coronary heart disease 16, 17, 18, 19, 20, 21, 22, 23, 24. Although these studies on fatty acids are primarily reported in relation to thrombus formation, a few studies discuss the effect on the progress of atherosclerosis [25]. Recently, the Japanese population has experienced changes in serum lipids; the ratio of serum ω3/ω6 fatty acids is decreased as the intake of fish decreases. We compared the serum lipid profiles of the patients with or without significant coronary stenosis and of the control subjects, and analysed the relationship between serum lipids and food intake. Using these results the importance of Japanese traditional foods such as dark-meat fish and soybean products in maintaining serum ω3 fatty acid levels in order to prevent an increase in coronary heart disease in Japan is discussed.

Section snippets

Materials and methods

The study district is Shimane Prefecture located in the western part of the main island of Japan, where the death rate from coronary heart disease of those 30–69 years old was 33 men and 13 women per 100 000 population in 1995. One hundred cardiovascular patients underwent elective diagnostic coronary angiography in a public hospital from August 1991 to July 1993. We studied 71 patients (18 women, 53 men) who had more than 25% stenosis in coronary arteries. One patient was excluded because of

Results

A comparison of serum lipids of the patients and the controls (Table 2) showed no differences in the levels of serum total cholesterol, LDL cholesterol and triglycerides. HDL cholesterol was significantly lower in the patients with stenosis than in the control subjects. The serum fatty acid composition of the phospholipids is shown in Table 3. Eicosapentaenoic acid was significantly lower in the patients with stenosis than in the control subjects. Arachidonic acid was significantly higher in

Discussion

Fatty acids are a main component in the cell and organelle membranes of organisms. In particular, the composition of fatty acids in phospholipids is not only associated with the cell membrane but also plays an important role in fatty acid metabolism such as the arachidonic acid cascade. The composition of fatty acids of the phospholipids clearly reflects the change of dietary habits [22]. Boberg et al. [20]reported that arachidonic acid of the platelet membrane phospholipids metabolise

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