Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
Eur J Heart Fail. 2013 Nov;15(11):1289-95. doi: 10.1093/eurjhf/hft103. Epub 2013 Jul 9.
In the last few years, n-3 polyunsaturated acids (PUFAs) have been extensively studied for the prevention of AF, mostly in patients without heart failure (HF) or LV dysfunction. This post-hoc analysis of the GISSI-HF trial assessed the effect of n-3 PUFAs on AF in patients with chronic HF without AF at study entry over a median follow-up of 3.9 years.
In the GISSI-HF trial, 6975 patients with chronic HF were randomized to 1 g daily of n-3 PUFAs or placebo on top of recommended therapy for HF. Of these, 1140 (16.3%) had AF at baseline ECG and were excluded from the present analysis. AF during the trial was defined as the presence of AF on the ECGs done at each visit during the trial or AF as a cause of worsening HF or hospital admission or as an event during hospitalization. Dietary fish consumption and the circulating levels of n-3 PUFAs (the latter in a subset of 1203 patients) were also available. Among the 5835 patients without AF at study entry, 444 randomized to n-3 PUFAs (15.2%) and 408 to placebo (14.0%) developed AF (unadjusted hazard 1.10, P = 0.19). Lower circulating n-3 PUFA levels were independently associated with higher AF prevalence at study entry, but not with its new occurrence.
Despite an inverse relationship between plasma n-3 PUFA levels and prevalent AF, this study found no evidence that 1 g daily n-3 PUFA supplementation in patients with chronic HF reduces incident AF.
在过去的几年中，n-3 多不饱和脂肪酸（PUFA）已被广泛研究用于预防房颤，主要是在没有心力衰竭（HF）或左心室功能障碍的患者中。本项 GISSI-HF 试验的事后分析评估了 n-3 PUFAs 对研究入组时无房颤的慢性 HF 患者房颤的影响，中位随访时间为 3.9 年。
在 GISSI-HF 试验中，6975 例慢性 HF 患者在推荐的 HF 治疗基础上随机分配至每天 1 克 n-3 PUFAs 或安慰剂。其中，1140 例（16.3%）基线心电图有房颤，被排除在本分析之外。试验期间的房颤定义为试验期间每次就诊时心电图上的房颤、房颤导致 HF 恶化或住院或住院期间的事件。饮食中鱼类的摄入量和 n-3 PUFAs 的循环水平（后者在 1203 例患者的亚组中）也可用。在研究入组时无房颤的 5835 例患者中，444 例随机分配至 n-3 PUFAs（15.2%），408 例分配至安慰剂（14.0%）发生房颤（未调整的危险比 1.10，P=0.19）。较低的循环 n-3 PUFAs 水平与研究入组时较高的房颤患病率独立相关，但与新发房颤无关。
尽管血浆 n-3 PUFAs 水平与房颤患病率呈负相关，但本研究并未发现每天 1 克 n-3 PUFAs 补充剂可降低慢性 HF 患者新发房颤的证据。
