Marchioli R, Silletta M G, Levantesi G, Pioggiarella R, Tognoni G
Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy.
Cell Mol Biol (Noisy-le-grand). 2010 Feb 25;56(1):110-30.
Over the past 20 years, there has been significant progress in our knowledge of the pathophysiology of heart failure (HF) with consequent considerable development of both pharmacological and non pharmacological approaches. Despite improved therapeutic strategies, HF still remains burdensome in terms of mortality, quality of life, and hospitalization costs. A new and promising medical treatment to improve survival in HF patients stems from the recent results of the Italian study, Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Heart Failure (GISSI-HF). GISSI-HF was a randomized, large scale, double-blind, placebo-controlled trial showing that n-3 PUFA (850-882 mg/d) reduced mortality and admission to the hospital for cardiovascular reasons in patients with chronic heart failure (HF) who were already receiving recommended therapies. The clinical benefit observed in GISSI-HF seemed to be mediated prominently by the antiarrhythmic effects of n-3 PUFA, though an effect on mechanisms related to HF progression cannot be excluded. This article presents the results of GISSI-HF study and reviews the previous clinical evidence on n-3 PUFA and risk of heart failure and discusses in depth the potential mechanisms through which n-3 PUFA treatment can improve clinical outcome in HF patients.
在过去20年里，我们对心力衰竭（HF）病理生理学的认识取得了显著进展，随之而来的是药理学和非药理学方法都有了相当大的发展。尽管治疗策略有所改进，但HF在死亡率、生活质量和住院费用方面仍然负担沉重。一种有望改善HF患者生存率的新型医学疗法源于意大利研究“心肌梗死存活研究组 - 心力衰竭（GISSI - HF）”的最新结果。GISSI - HF是一项随机、大规模、双盲、安慰剂对照试验，结果表明，在已经接受推荐治疗的慢性心力衰竭（HF）患者中，n - 3多不饱和脂肪酸（850 - 882毫克/天）可降低死亡率和因心血管原因住院的几率。GISSI - HF中观察到的临床益处似乎主要由n - 3多不饱和脂肪酸的抗心律失常作用介导，不过也不能排除其对与HF进展相关机制的影响。本文介绍了GISSI - HF研究的结果，回顾了先前关于n - 3多不饱和脂肪酸与心力衰竭风险的临床证据，并深入讨论了n - 3多不饱和脂肪酸治疗可改善HF患者临床结局的潜在机制。
