Heart failure (HF) patients with lower serum levels of alpha-linolenic acid (ALA), the main plant omega-3, may have a worse prognosis during follow-up, compared with individuals with higher levels, according to a study published Oct. 24 in JACC.

Iolanda Lázaro, PhD, et al., obtained data and blood samples from 905 ambulatory patients with HF between June 2006 and September 2020. The researchers tested blood samples for ALA levels and were broken down as a percentage of the total of 20 determined fatty acids. After a median follow-up of 2.4 years, the researchers documented 140 all-cause deaths, 85 cardiovascular deaths and 141 first HF hospitalizations.

The researchers observed “statistically significant reductions” for all-cause death (HR: 0.58; 95% CI: 0.41-0.82), cardiovascular death (HR: 0.51; 95% CI: 0.32-0.80), first HF hospitalization (HR: 0.58; 95% CI: 0.40-0.84), and the composite of cardiovascular death and HF hospitalization (HR: 0.58; 95% CI: 0.42-0.79).

They conclude that their findings show that once HF is present in an individual, increasing ALA levels may be tied to a better prognosis. In addition, plant-based diets may have a positive effect on HF prognosis, and foods rich in ALA (flaxseed oil, walnuts, chia and canola oil) are a possible preventive tool to stop or delay the continuum of HF.

“These findings would hopefully pave the way for future trials testing whether regular consumption of foods rich in ALA could serve as a preventive strategy to improve outcomes and promote quality of life in patients with HF and low circulating ALA,” the authors conclude.

In a related editorial comment, Abdallah Al-Mohammad, MD, notes, “Their proposal of a potential role for this source of nutrition in improving the morbidity and mortality rates of patients with HF cannot yet be substantiated.” He adds that the study “opens the field to more questions, particularly whether circulating plant-based omega-3 levels in HF are prognostic risk markers or therapeutic targets. The judge and jury for these cases shall be prospective randomized controlled clinical trials.”

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Nonstatins, Acute Heart Failure, Diet

Keywords: Morbidity, Diet, Vegetarian, Hospitalization, Heart Failure, Prospective Studies, Follow-Up Studies, Follow-Up Studies, Prognosis, Rapeseed Oil, Quality of Life, Linseed Oil, Juglans, alpha-Linolenic Acid

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