欧米伽-3 脂肪酸对冠状动脉血运重建和心血管事件的影响:一项荟萃分析。

IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European journal of preventive cardiology Pub Date : 2024-11-11 DOI:10.1093/eurjpc/zwae184
Monica Dinu, Francesco Sofi, Sofia Lotti, Barbara Colombini, Anna Vittoria Mattioli, Alberico L Catapano, Manuela Casula, Andrea Baragetti, Nathan D Wong, Philippe Gabriel Steg, Giuseppe Ambrosio
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引用次数: 0

摘要

目的:药用欧米伽-3 脂肪酸对预防心血管疾病的益处尚存争议。尤其是对冠状动脉血运重建的影响尚不明确;此外,对二十碳五烯酸(EPA)的具体益处也存在争议。我们调查了随机接受 EPA 或 EPA + 二十二碳六烯酸(EPA + DHA)与对照组的受试者中发生的冠状动脉血运重建、心肌梗死(MI)、中风、心力衰竭(HF)、不稳定型心绞痛和心血管死亡的情况:在对 MEDLINE、Embase、Scopus、Web of Science 和 Cochrane Library 进行检索后,对随机对照试验(RCTs)进行了 Meta 分析。在摘录数据、评估数据质量和有效性时,遵循了《系统综述和元分析首选报告项目》指南。采用随机效应模型对数据进行汇总。共纳入了 18 项 RCT,134 144 名参与者(一级和二级心血管预防)接受了 DHA + EPA(n = 52 498)、单独 EPA(n = 14 640)或对照/安慰剂(n = 67 006)治疗。随访时间从 4.5 个月到 7.4 年不等。总体而言,与对照组相比,补充欧米伽-3 可降低血管再通的风险 [0.90, 95% 置信区间 (CI) 0.84-0.98; P = 0.001; P- 异质性 = 0.0002;I2 = 68%]、心肌梗死(0.89,95% CI 0.81-0.98;P = 0.02;P-异质性 = 0.06;I2 = 41%)和心血管死亡(0.92,95% CI 0.85-0.99;P = 0.02;P-异质性 = 0.13;I2 = 33%)。在大多数参与者(≥60%)接受他汀类药物治疗的试验中仍观察到较低的风险。与 DHA + EPA 相比,单用 EPA 可进一步显著降低血管再通的风险(0.76,95% CI 0.65-0.88;P = 0.0002;P-交互作用 = 0.005)以及除高频以外的所有结果:结论:无论是否使用他汀类药物,补充欧米伽-3 脂肪酸都能降低心血管事件和冠状动脉血运重建的风险。仅二十碳五烯酸就能产生更大的益处。特定欧米伽-3分子在一级预防和二级预防中的作用,以及减少血管再通对总体健康状况和节约成本的潜在益处值得进一步研究。
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Effects of omega-3 fatty acids on coronary revascularization and cardiovascular events: a meta-analysis.

Aims: Benefits of pharmacologic omega-3 fatty acid administration in cardiovascular prevention are controversial. Particularly, effects on coronary revascularization are unclear; also debated are specific benefits of eicosapentaenoic acid (EPA). We investigated incident coronary revascularizations, myocardial infarction (MI), stroke, heart failure (HF), unstable angina, and cardiovascular death, in subjects randomized to receive EPA or EPA + docosahexaenoic acid (EPA + DHA) vs. control.

Methods and results: Meta-analysis of randomized controlled trials (RCTs) was conducted after MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library search. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed for abstracting data and assessing data quality and validity. Data were pooled using a random effects model. Eighteen RCTs with 134 144 participants (primary and secondary cardiovascular prevention) receiving DHA + EPA (n = 52 498), EPA alone (n = 14 640), or control/placebo (n = 67 006) were included. Follow-up ranged from 4.5 months to 7.4 years. Overall, compared with controls, omega-3 supplementation reduced the risk of revascularization [0.90, 95% confidence interval (CI) 0.84-0.98; P = 0.001; P-heterogeneity = 0.0002; I2 = 68%], MI (0.89, 95% CI 0.81-0.98; P = 0.02; P-heterogeneity = 0.06; I2 = 41%), and cardiovascular death (0.92, 95% CI 0.85-0.99; P = 0.02; P-heterogeneity = 0.13; I2 = 33%). Lower risk was still observed in trials where most participants (≥60%) were on statin therapy. Compared with DHA + EPA, EPA alone showed a further significant risk reduction of revascularizations (0.76, 95% CI 0.65-0.88; P = 0.0002; P-interaction = 0.005) and all outcomes except HF.

Conclusion: Omega-3 fatty acid supplementation reduced the risk of cardiovascular events and coronary revascularization, regardless of background statin use. Eicosapentaenoic acid alone produced greater benefits. The role of specific omega-3 molecules in primary vs. secondary prevention and the potential benefits of reduced revascularizations on overall health status and cost savings warrant further research.

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来源期刊
European journal of preventive cardiology
European journal of preventive cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
12.50
自引率
12.00%
发文量
601
审稿时长
3-8 weeks
期刊介绍: European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.
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