In 42,392 UK Biobank participants free of coronary heart disease and heart failure at baseline, elevated plasma heart-type fatty acid-binding protein (H-FABP) in the top versus bottom tertile was associated with 29% higher CHD risk, 54% higher MI risk, 95% higher heart failure risk, and a doubling of CHD mortality. The most striking finding was a statistically significant interaction with omega-3 fatty acid status. Among participants with low omega-3 levels, the CHD hazard ratio reached 1.41 and MI hazard ratio hit 2.23 — a clinically substantial elevation. Among those with high omega-3 levels, these associations shrank to statistical insignificance (HR 1.15 for CHD; 1.11 for MI).
H-FABP is primarily studied as an acute diagnostic biomarker, so this large prospective cohort demonstrating long-term cardiovascular prediction adds meaningful depth to its clinical profile. More consequentially, the omega-3 interaction suggests a tractable intervention point: adults with elevated H-FABP — reflecting chronic fatty acid transport stress — may derive disproportionate cardiovascular protection from optimizing omega-3 intake. This aligns with mechanistic work showing omega-3s reduce lipotoxicity and inflammation in cardiomyocytes. Limitations include the observational design precluding causality, single baseline omega-3 measurement, and that H-FABP isn't a routine clinical test. Still, the finding reinforces omega-3 supplementation as potentially more than incrementally beneficial for high-risk individuals, and positions H-FABP as a future risk-stratification tool.