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Recently, the balance of n-3\/n-6 polyunsaturated fatty acids (PUFAs) has received attention as a risk marker for CVD but, so far, no study has been conducted that investigates the association between BMI and the balance of n-3\/n-6 PUFAs for CVD risk.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We evaluated the association between n-3\/n-6 PUFA ratio and acute coronary syndrome (ACS) in three BMI-based groups (&lt;\u200925: low BMI, 25\u201327.5: moderate BMI, and\u2009\u2265\u200927.5: high BMI) that included 1666 patients who visited the cardiovascular medicine departments of five hospitals located in urban areas in Japan.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The prevalence of ACS events was 9.2, 7.3, and 10.3% in the low, moderate, and high BMI groups, respectively. We analyzed the relationship between ACS events and several factors, including docosahexaenoic acid\/arachidonic acid (DHA\/AA) ratio by multivariate logistic analyses. In the low BMI group, a history of smoking (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.40\u20134.35) and low DHA\/AA ratio (OR: 0.30, 95% CI: 0.12\u20130.74) strongly predicted ACS. These associations were also present in the moderate BMI group but the magnitude of the association was much weaker (ORs are 1.47 [95% CI: 0.54\u20134.01] for smoking and 0.63 [95% CI: 0.13\u20133.10] for DHA\/AA). In the high BMI group, the association of DHA\/AA (OR: 1.98, 95% CI: 0.48\u20138.24) was reversed and only high HbA1c (OR: 1.46, 95% CI: 1.03\u20132.08) strongly predicted ACS. The interaction test for OR estimates (two degrees of freedom) showed moderate evidence for reverse DHA\/AA ratio\u2013ACS associations among the BMI groups (<jats:italic>P<\/jats:italic>\u2009=\u20090.091).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>DHA\/AA ratio may be a useful marker for risk stratification of ACS, especially in non-obese patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12872-020-01445-w","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T16:03:57Z","timestamp":1586189037000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Association between the ratio of serum n-3 to n-6 polyunsaturated fatty acids and acute coronary syndrome in non-obese patients with coronary risk factor: a multicenter cross-sectional study"],"prefix":"10.1186","volume":"20","author":[{"given":"Yuji","family":"Nishizaki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Shimada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigemasa","family":"Tani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takayuki","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiro","family":"Ando","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masao","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masato","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Shinozaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuro","family":"Miyazaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsumi","family":"Miyauchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Nagao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Hirayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michihiro","family":"Yoshimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Issei","family":"Komuro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryozo","family":"Nagai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Daida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,4,6]]},"reference":[{"key":"1445_CR1","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.annepidem.2004.05.012","volume":"15","author":"D McGee","year":"2005","unstructured":"McGee D, Diverse Populations Collaboration. 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Informed consent was obtained under opt-out agreement.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"KS, ST, and KM received lecture fees from Mochida Pharmaceutical Company and Takeda Pharmaceutical Company. MY received scholarship funds and lecture fees from Mochida Pharmaceutical Company and Takeda Pharmaceutical Company. IK received lecture fees and scholarship funds from Takeda Pharmaceutical Company. RN received consultation and lecture fees from Mochida Pharmaceutical Company. HD received scholarship funds and lecture fees from Mochida Pharmaceutical Company and Takeda Pharmaceutical Company. The other authors report no conflicts.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"160"}}