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N-3 多不饱和脂肪酸预防心房颤动：随机对照试验的更新系统评价和荟萃分析。

N-3 polyunsaturated fatty acids to prevent atrial fibrillation: updated systematic review and meta-analysis of randomized controlled trials.

机构信息

Fundación GESICA (Grupo de Estudio de Investigacíon Clínica en Argentina), Buenos Aires, Argentina.

出版信息

J Am Heart Assoc. 2013 Feb 19;2(1):e005033. doi: 10.1161/JAHA.112.005033.

DOI:10.1161/JAHA.112.005033
PMID:23525440
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3603239/
Abstract

BACKGROUND

Previous studies have suggested that n-3 polyunsaturated fatty acids (n-3 PUFAs) have antiarrhythmic effects on atrial fibrillation (AF). We aimed to assess the effects of therapy with n-3 PUFAs on the incidence of recurrent AF and on postoperative AF.

METHODS AND RESULTS

Electronic searches were conducted in Web of Science, Medline, Biological Abstracts, Journal Citation Reports, and the Cochrane Central Register of Controlled Trials databases. In addition, data from the recently completed FORωARD and OPERA trials were included. We included randomized controlled trials comparing treatment with n-3 PUFAs versus control to (1) prevent recurrent AF in patients who underwent reversion of AF or (2) prevent incident postoperative AF after cardiac surgery. Of identified studies, 12.9% (16 of 124) were included, providing data on 4677 patients. Eight studies (1990 patients) evaluated n-3 PUFA effects on AF recurrence among patients with reverted AF and 8 trials (2687 patients) on postoperative AF. Pooled risk ratios through random-effects models showed no significant effects on AF recurrence (RR, 0.95; 95% CI, 0.79 to 1.13; I(2), 72%) or on postoperative AF (0.86; 95% CI, 0.71 to 1.04; I(2), 53.1%). A funnel plot suggested publication bias among postoperative trials but not among persistent AF trials. Meta-regression analysis did not find any relationship between doses and effects (P=0.887 and 0.833 for recurrent and postoperative AF, respectively).

CONCLUSIONS

Published clinical trials do not support n-3 PUFAs as agents aimed at preventing either postoperative or recurrent AF.

CLINICAL TRIAL REGISTRATION

URL: http://www.crd.york.ac.uk/PROSPERO. Unique Identifier: CRD42012002199.

摘要

背景

先前的研究表明，n-3 多不饱和脂肪酸（n-3 PUFAs）对心房颤动（AF）具有抗心律失常作用。我们旨在评估 n-3 PUFAs 治疗对复发性 AF 和术后 AF 的影响。

方法和结果

在 Web of Science、Medline、Biological Abstracts、Journal Citation Reports 和 Cochrane 对照试验中心注册数据库中进行电子检索。此外，还包括最近完成的 FORωARD 和 OPERA 试验的数据。我们纳入了比较 n-3 PUFAs 治疗与对照组的随机对照试验，以（1）预防 AF 转复患者的复发性 AF，或（2）预防心脏手术后的新发术后 AF。在所确定的研究中，有 12.9%（124 项中的 16 项）被纳入，提供了 4677 名患者的数据。8 项研究（1990 名患者）评估了 n-3 PUFA 对 AF 转复患者 AF 复发的影响，8 项试验（2687 名患者）评估了术后 AF。通过随机效应模型汇总的风险比显示，在 AF 复发（RR，0.95；95%CI，0.79 至 1.13；I²，72%）或术后 AF（0.86；95%CI，0.71 至 1.04；I²，53.1%）方面无显著效果。漏斗图表明术后试验存在发表偏倚，但持续性 AF 试验则没有。Meta 回归分析未发现剂量与效果之间存在任何关系（分别为复发性和术后 AF 的 P=0.887 和 0.833）。

结论

已发表的临床试验不支持 n-3 PUFAs 作为预防术后或复发性 AF 的药物。

临床试验注册

网址：http://www.crd.york.ac.uk/PROSPERO. 独特标识符：CRD42012002199.

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