Omega-3 index improves upon the pooled cohort equation in predicting risk for CVD

Accurate predictive tools are crucial for identifying patients at increased risk for atherosclerotic cardiovascular disease (ASCVD). The Pooled Cohort Equation (PCE) is commonly used to predict 10-year risk for ASCVD, but its accuracy remains imperfect.

This study examined the extent to which the omega-3 index (O3I; the proportion of eicosapentaenoic acid+docosahexaenoic acid in erythrocyte membranes) improved the predictive capability of PCE.

The O3I was determined in 2550 participants without ASCVD at baseline from Framingham Offspring Cohort. The extent to which the O3I added to the PCE score was assessed using area under the curve (AUC). We also estimated how much the O3I added predictive power to each standard risk factor (blood pressure, diabetes, smoking, total and high-density lipoprotein cholesterol [HDL-C]) individually when added to the basic age+sex+race model. Mean follow-up was 9.1 years.

The AUC predicting 10-year ASCVD events using PCE was 0.689. It increased to 0.698 (P < .05) upon addition of the O3I. The AUC additions to the basic model were 0.028 (blood pressure, HDL-C), 0.020 (diabetes), 0.012 (O3I), 0.006 (cholesterol), and 0.004 (smoking); all but smoking were significant (P < .05). Also, the O3I significantly (P < .05) improved the predictive ability of each of these risk factors when analyzed separately.

The O3I improved the PCE prediction, suggesting that it captures risk beyond standard factors. Thus, the O3I may help in ASCVD risk stratification. Further research is needed to extend these findings into more diverse cohorts and to explore the integration of O3I into other existing ASCVD risk assessment tools.