Laboratoire Coeur et Nutrition, TIMC-IMAG CNRS 5525, Université Joseph Fourier, Faculté de Médecine de Grenoble, 38054 La Tronche, France.
BMC Med. 2013 Jan 4;11:5. doi: 10.1186/1741-7015-11-5.
Early randomized controlled trials (RCTs) demonstrated the health benefits of omega-3 fatty acids (n-3), whereas recent RCTs were negative. We now address the issue, focusing on the temporal changes having occurred: most patients in recent RCTs are no longer n-3 deficient and the vast majority are now treated with statins. Recent RCTs testing n-3 against arrhythmias suggest that n-3 reduce the risk only in patients not taking a statin. Other recent RCTs in secondary prevention were negative although, in a post-hoc analysis separating statin users and non-users, non-significant protection of n-3 was observed among statin non-users whereas statin users had no effect. Recent RCTs testing statins - after the implementation of the New Clinical Trial Regulation in 2007 - are negative (or flawed) suggesting that the lack of effect of n-3 cannot be attributed to a parallel protection by statins. Finally, statins favor the metabolism of omega-6 fatty acids (n-6), which in turn inhibits n-3 and, contrary to n-3, they increase insulin resistance and the risk of diabetes. Thus, n-3 and statins are counteractive at several levels and statins appear to inhibit n-3.
早期的随机对照试验(RCT)证明了ω-3 脂肪酸(n-3)的健康益处,而最近的 RCT 则得出了否定的结果。我们现在关注的是已经发生的时间变化:最近 RCT 中的大多数患者不再缺乏 n-3,而且绝大多数患者现在都接受他汀类药物治疗。最近针对心律失常的 n-3 试验表明,n-3 仅在未服用他汀类药物的患者中降低风险。其他最近的二级预防 RCT 也是阴性的,尽管在他汀类药物使用者和非使用者的事后分析中,他汀类药物非使用者中观察到 n-3 的非显著性保护作用,而他汀类药物使用者则没有效果。最近的 RCT 测试他汀类药物 - 在 2007 年实施新临床试验法规之后 - 也是阴性的(或有缺陷的),这表明 n-3 的缺乏效果不能归因于他汀类药物的平行保护。最后,他汀类药物有利于促进ω-6 脂肪酸(n-6)的代谢,而 n-6 反过来又抑制 n-3,与 n-3 相反,它们会增加胰岛素抵抗和糖尿病的风险。因此,n-3 和他汀类药物在多个层面上相互作用,而他汀类药物似乎抑制了 n-3。