Pathophysiology of long-chain polyene fatty acids in heart muscle

The polyene fatty acid composition of cardiac phospholipids is modified by age, diet and stress in the rat. In the aging heart there is a progressive replacement of 18:2n6 by 20:4n6 in phosphatidylcholine (PC) and a replacement of 18:2n6 by 22:6n3 in phosphatidylethanolamine (PE). Norepinephrine stress accelerates aging of cardiac PC and PE. Dietary fish oil causes a replacement of 18:2n6 and 20:4n6 by 22:6n3 in cardiac PC and PE but not in cardiolipin. Studies on human cardiac autopsy samples suggest that: (a) polyene fatty acid composition changes with age; (b) stability of cardiac phospholipids is a function of the fatty acid composition, chain length and unsaturation; (c) coronary atherosclerosis is associated with a reduced content of 18:2n6 in phospholipids, an increased content of glycerides of abnormal composition and an unexpectedly low level of free fatty acids (FFA) in the heart muscle, and (d) many cases of sudden cardiac death in the absence of marked coronary artery stenosis or myocardial infarction may be associated with significant alterations in myocardial levels of FFA (increase) or PE (decrease).