Departments of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
Circulation. 2012 Mar 6;125(9):1084-93. doi: 10.1161/CIRCULATIONAHA.111.062653. Epub 2012 Jan 26.
Experimental studies suggest that long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) may reduce the risk of atrial fibrillation (AF). Prior studies evaluating fish or n-3 PUFA consumption from dietary questionnaires and incident AF have been conflicting. Circulating levels of n-3 PUFAs provide an objective measurement of exposure.
Among 3326 US men and women ≥65 years of age and free of AF or heart failure at baseline, plasma phospholipid levels of eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid were measured at baseline by use of standardized methods. Incident AF (789 cases) was identified prospectively from hospital discharge records and study visit ECGs during 31 169 person-years of follow-up (1992-2006). In multivariable Cox models adjusted for other risk factors, the relative risk in the top versus lowest quartile of total n-3 PUFAs (eicosapentaenoic acid+docosapentaenoic acid+docosahexaenoic acid) levels was 0.71 (95% confidence interval, 0.57-0.89; P for trend=0.004) and of DHA levels was 0.77 (95% confidence interval, 0.62-0.96; P for trend=0.01). Eicosapentaenoic acid and docosapentaenoic acid levels were not significantly associated with incident AF. Evaluated nonparametrically, both total n-3 PUFAs and docosahexaenoic acid showed graded and linear inverse associations with incidence of AF. Adjustment for intervening events such as heart failure or myocardial infarction during follow-up did not appreciably alter results.
In older adults, higher circulating total long-chain n-3 PUFA and docosahexaenoic acid levels were associated with lower risk of incident AF. These results highlight the need to evaluate whether increased dietary intake of these fatty acids could be effective for the primary prevention of AF.
实验研究表明，长链 n-3 多不饱和脂肪酸（n-3PUFA）可能降低心房颤动（AF）的风险。先前评估来自饮食问卷的鱼类或 n-3PUFA 消耗与新发 AF 的研究结果相互矛盾。循环 n-3PUFA 水平提供了暴露的客观测量。
在 3326 名年龄≥65 岁且基线时无 AF 或心力衰竭的美国男性和女性中，通过使用标准化方法在基线时测量了血浆磷脂中二十碳五烯酸、二十二碳五烯酸和二十二碳六烯酸的水平。前瞻性地从医院出院记录和研究访视期间的心电图中确定了新发 AF（789 例），在 31169 人年的随访期间（1992-2006 年）。在调整了其他危险因素的多变量 Cox 模型中，总 n-3PUFA（二十碳五烯酸+二十二碳五烯酸+二十二碳六烯酸）水平最高与最低四分位数相比的相对风险比为 0.71（95%置信区间，0.57-0.89；趋势 P 值=0.004），DHA 水平为 0.77（95%置信区间，0.62-0.96；趋势 P 值=0.01）。二十碳五烯酸和二十二碳五烯酸水平与新发 AF 无显著相关性。非参数评估显示，总 n-3PUFA 和二十二碳六烯酸与 AF 发生率均呈分级和线性反比关系。随访期间发生心力衰竭或心肌梗死等中间事件的调整并未明显改变结果。
在老年人中，循环总长链 n-3PUFA 和二十二碳六烯酸水平较高与新发 AF 风险降低相关。这些结果强调了需要评估增加这些脂肪酸的饮食摄入是否能有效预防 AF 的发生。
