Association between polyunsaturated fatty acids and cerebral small vessel disease in ischemic stroke patients

To clarify the association between polyunsaturated fatty acids (PUFAs) and cerebral small vessel disease (SVD) in ischemic stroke patients.

Consecutive patients with ischemic stroke admitted between 2012 and 2022 were screened. Inclusion criteria were availability of PUFA measurements and SVD markers evaluation on MRI. Plasma PUFAs levels, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), dihomo-γ-linolenic acid (DGLA) and arachidonic acid (AA), were assayed. Severe SVD burden was defined as a total SVD score of 3 or more.

We screened 2,112 consecutive ischemic stroke patients, including 1,710 (1,226 [72%] males, median age 69 years). Lower EPA levels were associated with a severe SVD burden (prevalence ratio (PR) 0.982, 95% CI 0.966-0.998, p = 0.032), while higher DHA levels were associated with an increased SVD burden (PR 1.263, 95% CI 1.089-1.466, p = 0.002). Further, lower EPA levels were linked to the presence of old lacunes (PR 0.986, 95% CI 0.974-0.999, p = 0.031) and a higher grade of white matter hyperintensities (WMH) (PR 0.985, 95% CI 0.971-1.000, p = 0.043). Conversely, higher DHA levels were associated with the presence of old lacunes (PR 1.136, 95% CI 1.016-1.271, p = 0.026), a higher WMH grade (PR 1.302, 95% CI 1.140-1.486, p < 0.001), and a higher enlarged perivascular spaces grade (PR 1.163, 95% CI 1.023-1.323, p = 0.021). No significant association was found between DGLA or AA levels and SVD.

Among ischemic stroke patients, EPA might have a protective role against SVD, whereas DHA might have an opposite effect.