Study finds women with non-obstructive coronary artery disease have low levels of PRMs

Women with ischemic heart disease due to dysfunction of the small blood vessels that supply blood to the heart have lower levels of a downstream product of omega-3 fatty acids compared with women who did not have the condition, according to a study published in the American Journal of Cardiology on October 30, 2021. 1

These inflammation-fighting molecules are called pro-resolving mediators (PRMs), also known as specialized pro-resolving mediators (SPMs), and are made by immune cells from omega-3 fatty acids.

A large percentage of women who experience chest pain due to coronary ischemia do not have atherosclerotic plaques narrowing the blood vessels and limiting blood flow to the heart. Instead, their symptoms appear to be due to coronary microvascular dysfunction. Although what causes dysfunction of these small blood vessels in the heart is not completely understood, evidence supports chronic inflammation and ineffective clearing of dead cells and cellular debris as a factor involved in its development.

Women with coronary microvascular dysfunction may not be able to resolve inflammation in the heart due to insufficient production or ineffective activity of PRMs, the study researchers proposed.

The current study involved 31 participants in The Women’s Ischemia Trial to Reduce Events in Nonobstructive Coronary Artery Disease (WARRIOR) who were shown to have coronary microvascular dysfunction. Blood samples were analyzed for PRMs and other factors.

Compared to a group of 12 women of a similar age who do not have this disorder, women with coronary microvascular dysfunction had significantly lower levels of the PRM known as resolvin D1 and undetectable levels of the PRM maresin 1, which are both downstream products of the omega-3 fatty acid DHA. The authors suggested that the low levels of resolvin D1 and maresin 1 measured in this study could be the result of a block in the conversion of the omega 3 fatty acid DHA to PRMs, faster breakdown of these PRMs or other factors.

“Insufficient or ineffective PRM production may play a role in the pathophysiology of coronary microvascular dysfunction,” the authors of the report concluded. “These studies provide a strong foundation to investigate the effect of PRM in coronary microvascular dysfunction and inflammation.”

“If our results are validated in a larger cohort, omega 3 fatty acid intake could be tested as a novel treatment for these patients.”


Apply What You've Learned: Pro-resolving mediators (PRMs)

  • Pro-resolving mediators are molecules that play a role in resolving inflammation. Unhealthy levels of inflammation are associated with chronic diseases like diabetes as well as obesity and aging.2
  • Avoid excessive saturated fat and sugar intake to help support a healthy inflammatory response.3,4 Lowering calorie intake may also be protective.5
  • Many nutrients and foods are also protective. Vitamin D and E, magnesium, selenium and zinc, tea and curcumin support a healthy level of inflammation.6-11
  • Keep tabs on your inflammation levels by getting regular blood tests, including tests for high-sensitivity C-reactive protein (hs-CRP) and fibrinogen, which can detect the presence of inflammation.


  1. Keeley EC et al. Am J Cardiol. 2021 Oct 30;S0002-9149(21)00928-0.
  2. Frasca D, et al. Frontiers in immunology. 2017 Dec 7;8:1745.
  3. Rocha DM et al. Atherosclerosis. 2016 Jan;244:211-5.
  4. Lin WT, et al. Int J Public Health. 2020 Jan;65(1):45-53.
  5. González O et al. Oral Dis. 2012 Jan;18(1):16-31.
  6. Mousa A et al. Nutr Rev. 2018 May 1;76(5):380-394.
  7. Singh U et al. Vitam Horm. 2007;76:519-49.
  8. Maier JA et al. Semin Cell Dev Biol. 2021 Jul;115:37-44.
  9. Duntas LH. Horm Metab Res. 2009 Jun;41(6):443-7.
  10. Ohishi T et al. Antiinflamm Antiallergy Agents Med Chem. 2016;15(2):74-90.
  11. He Y et al. Molecules. 2015 May 20;20(5):9183-213.

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