von Schacky Clemens
Preventive Cardiology, University of Munich, and Omegametrix, Martinsried, Germany.
Curr Opin Clin Nutr Metab Care. 2008 Mar;11(2):94-9. doi: 10.1097/MCO.0b013e3282f44bdf.
Recent publications seem to indicate no or an untoward effect of the marine omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid on cardiac rhythm. This review puts these developments into perspective.
In-vitro or in animal models, little pro-arrhythmic effect, but many antiarrhythmic mechanisms of omega-3 fatty acids have been documented. In intervention studies in humans, eicosapentaenoic acid plus docosahexaenoic acid suppressed new atrial fibrillation in patients undergoing coronary bypass grafting. More importantly, in systematic reviews, it has been demonstrated that eicosapentaenoic acid plus docosahexaenoic acid reduce sudden cardiac death by 50%. In a recently published intervention study with eicosapentaenoic acid in patients at high cardiovascular risk in Japan, sudden cardiac death was rare. Sudden cardiac death is even rarer in the general population of Japan: it occurs 20 times less frequently than in the general population in Europe, e.g. Germany. In Japan, levels of eicosapentaenoic acid plus docosahexaenoic acid are high (omega-3 index estimated around 11%), whereas in Germany levels of eicosapentaenoic acid plus docosahexaenoic acid acids are low (omega-3 index around 4%). These and other data strengthen the concept that a low omega-3 index is a risk factor for sudden cardiac death, as a tool to assess the status of a person in terms of eicosapentaenoic acid plus docosahexaenoic acid, and as a means to monitor therapy with eicosapentaenoic acid plus docosahexaenoic acid.
Concerns about pro-arrhythmic effects of eicosapentaenoic acid plus docosahexaenoic acid are largely theoretical. The evidence in favour of an antiarrhythmic effect is overwhelming, especially, when factoring in the omega-3 index.
近期的出版物似乎表明，海洋ω-3脂肪酸二十碳五烯酸和二十二碳六烯酸对心律没有影响或有不良影响。本综述将这些进展置于正确的视角。
在体外或动物模型中，ω-3脂肪酸几乎没有促心律失常作用，但已记录到许多抗心律失常机制。在人体干预研究中，二十碳五烯酸加二十二碳六烯酸可抑制冠状动脉搭桥术患者新发房颤。更重要的是，在系统评价中，已证明二十碳五烯酸加二十二碳六烯酸可使心源性猝死减少50%。在日本最近发表的一项针对心血管高危患者的二十碳五烯酸干预研究中，心源性猝死很少见。心源性猝死在日本普通人群中甚至更罕见：其发生率比欧洲普通人群（如德国）低20倍。在日本，二十碳五烯酸加二十二碳六烯酸的水平较高（ω-3指数估计约为11%），而在德国，二十碳五烯酸加二十二碳六烯酸的水平较低（ω-3指数约为4%）。这些数据以及其他数据强化了这样一种观念，即低ω-3指数是心源性猝死的一个危险因素，可作为评估一个人二十碳五烯酸加二十二碳六烯酸状态的工具，以及监测二十碳五烯酸加二十二碳六烯酸治疗的手段。
对二十碳五烯酸加二十二碳六烯酸促心律失常作用的担忧在很大程度上是理论上的。支持其抗心律失常作用的证据压倒性地充分，特别是考虑到ω-3指数时。
