Insulin Resistance Modifies the Effects of Omega-3 Acid Ethyl Esters on Left Ventricular Remodeling After Acute Myocardial Infarction (from the OMEGA-REMODEL Randomized Clinical Trial) - 10/02/20
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Résumé |
Insulin resistance early after acute myocardial infarction is associated with increased heart failure and mortality. OMEGA-REMODEL was a prospective double-blind 1:1 randomized control trial of patients with AMI. We reported that 6-month treatment with omega-3 fatty acid (O-3FA) 4 g/day attenuated cardiac remodeling accompanied by reduction in inflammation. We hypothesized that insulin resistance modifies the therapeutic effect of O-3FA on post-MI cardiac remodeling. The OMEGA-REMODEL study group was dichotomized according to cohort- and gender-specific median cutoff value of leptin-to-adiponectin ratio (LAR) at baseline (LAR-Hi vs LAR-Lo). Mixed model regression analyses were used to evaluate effect modification of O-3FA on reduction of left ventricular end-systolic volume index (LVESVI) by LAR status. Baseline LAR was evaluated on 325 patients (59 ± 11 years, 81% male). A total of 168 patients were categorized in LAR-Lo, and 157 in LAR-Hi. O-3FA treatment resulted in significant LVESVI reduction in patients with LAR-Lo but not with LAR-Hi (p = 0.0002 vs 0.66, respectively). Mixed model regression analysis showed significant modification of LAR on O-3FA's treatment effect in attenuating LVESVI (p = 0.021). In conclusion, this post-hoc efficacy analysis suggests that LAR status significantly modified O-3FA's treatment effect in attenuating cardiac remodeling. During the convalescent phase of acute infarct healing, patients with lower insulin resistance estimated by LAR appear to derive more therapeutic response from O-3FA toward improvement of LVESVI.
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Clinical trial registration information: National Heart, Lung, and Blood Institute (NHLBI), NCT00729430, clinicaltrials.gov Identifier: NCT00729430. |
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Grant support: The National Institutes of Health provided sole funding for this study, while GlaxoSmithKline (Research Triangle Park, NC) provided study medication. The National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) funded this study entirely (R01HL091157). Dr. Fujikura received salary support from a T-32 training grant from NIH (T32HL094301-07). In addition, this work was funded in part by the Division of Intramural Research, NHLBI, NIH, United States 501100000276 and Human Services (DHHS). |
Vol 125 - N° 5
P. 678-684 - mars 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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