Calder P C, Yaqoob P
Developmental Origins of Health and Disease Division and Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.
Cell Mol Biol (Noisy-le-grand). 2010 Feb 25;56(1):28-37.
Long-chain n-3 polyunsaturated fatty acids are found in oily fish and in fish oils and similar preparations. Substantial evidence from epidemiological and case-control studies indicates that consumption of fish, oily fish and long-chain n-3 fatty acids reduces risk of cardiovascular mortality. Secondary prevention studies using long-chain n-3 fatty acids in patients post-myocardial infarction have shown a reduction in total and cardiovascular mortality with an especially potent effect on sudden death. Long-chain n-3 fatty acids have been shown to beneficially modify a range of cardiovascular risk factors, which may result in primary cardiovascular prevention. However, reduced non-fatal and fatal events and a reduction in sudden death probably involve other mechanisms. Reduced thrombosis following long-chain n-3 fatty acids may play a role. A decrease in arrhythmias is a favoured mechanism of action of long-chain n-3 fatty acids and is supported by cell culture and animal studies. However human trials using implantable cardiac defibrillators have produced inconsistent findings and a recent meta-analysis does not support this mechanism of action. An alternative mechanism of action may be stabilisation of atherosclerotic plaques by long-chain n-3 fatty acids. This is suggested by one published human study which showed that incorporation of long-chain n-3 fatty acids into plaques collected at carotid endarterectomy resulted in fewer macrophages in the plaque and a morphology indicative of increased stability. These findings are supported from observations in an animal model and suggest that the primary effect of long-chain n-3 fatty acids might be on macrophages within the plaque.
长链n-3多不饱和脂肪酸存在于油性鱼类、鱼油及类似制剂中。流行病学和病例对照研究的大量证据表明，食用鱼类、油性鱼类和长链n-3脂肪酸可降低心血管疾病死亡率。在心肌梗死后患者中使用长链n-3脂肪酸的二级预防研究显示，总死亡率和心血管疾病死亡率均有所降低，对猝死的影响尤为显著。长链n-3脂肪酸已被证明可有益地改变一系列心血管危险因素，这可能有助于一级心血管预防。然而，非致命和致命事件的减少以及猝死的减少可能涉及其他机制。长链n-3脂肪酸后血栓形成减少可能起到了一定作用。心律失常的减少是长链n-3脂肪酸的一种常见作用机制，细胞培养和动物研究也支持这一点。然而，使用植入式心脏除颤器的人体试验结果并不一致，最近的一项荟萃分析也不支持这种作用机制。另一种作用机制可能是长链n-3脂肪酸使动脉粥样硬化斑块稳定。一项已发表的人体研究表明，在颈动脉内膜切除术中收集的斑块中加入长链n-3脂肪酸后，斑块中的巨噬细胞减少，且形态显示稳定性增加，这表明了这一点。动物模型中的观察结果支持了这些发现，并表明长链n-3脂肪酸的主要作用可能是针对斑块内的巨噬细胞。
