{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:05:23Z","timestamp":1790661923100,"version":"4.1.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The eicosapentaenoic acid to arachidonic acid (EPA\/AA) ratio reflects the balance between n-3 and n-6 polyunsaturated fatty acids. We examined the association between the serum free (non-esterified) EPA\/AA ratio and long-term major adverse cardiovascular events (MACE) in patients with angiographically confirmed coronary artery disease (CAD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study included 308 patients with CAD. Serum free fatty acids were quantified by LC-MS\/MS, and the free EPA\/AA ratio was evaluated as the primary fatty-acid biomarker. Cox proportional hazards models were used to estimate hazard ratios (HRs), and principal component analysis (PCA) was used to explore fatty-acid patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow-up of 48.7 months, 201 first MACE events occurred. In the fully adjusted primary analysis, each 1-SD increase in the free EPA\/AA ratio was associated with a lower risk of MACE (HR\u2009=\u20090.82, 95% CI 0.70\u20130.96,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.011; FDR-adjusted\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.049). The association was attenuated after additional adjustment for analytical batch (HR\u2009=\u20090.92, 95% CI 0.77\u20131.10,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.375) and in a Cox model stratified by batch (HR\u2009=\u20090.92, 95% CI 0.77\u20131.11,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.398).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A higher serum free EPA\/AA ratio was associated with a lower risk of MACE in the primary multivariable analysis, but the association was attenuated in additional sensitivity analyses. These findings should be interpreted cautiously and require validation in independent cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1944383","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:48:04Z","timestamp":1790660884000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Serum free eicosapentaenoic acid-to-arachidonic acid ratio and long-term risk of major adverse cardiovascular events in patients with coronary artery disease"],"prefix":"10.3389","volume":"13","author":[{"given":"Changguo","family":"Ou","sequence":"first","affiliation":[{"name":"The First Clinical Medical College of Guangdong Medical University","place":["Zhanjiang, China"]},{"name":"Department of Cardiology, Foshan Second People\u2019s Hospital","place":["Foshan, 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