Professor of Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD; President, OmegaQuant Analytics, LLC, Sioux Falls, SD; Senior Research Scientist, Health Diagnostic Laboratory, Inc, Richmond, VA.
Postgrad Med. 2013 Nov;125(6):100-13. doi: 10.3810/pgm.2013.11.2717.
The omega-3 fatty acids (FA) found in fish oils, eicosapentaenoic and docosahexaenoic acids (EPA and DHA, respectively), have been extensively studied therapeutically in a wide variety of disease conditions, but in none more than cardiovascular disease (CVD). Our review summarizes mechanisms of action, recent meta-analyses of CVD outcome trials, sources (fish and supplements), and recommendations for use of omega-3 FA in clinical practice. With the ability to now measure the omega-3 FA biostatus through blood tests, patients can achieve cardioprotective levels by either taking fish oil supplements or simply eating more oily fish. Two omega-3 FA formulations (both in the ethyl ester form) have been approved by the US Food and Drug Administration (FDA) for the treatment of patients with very high triglyceride levels (> 500 mg/dL); one contains both EPA and DHA, whereas the other contains only EPA. The agents have been extensively tested in 2 patient populations, those with very high triglycerides and those with triglycerides between 200 and 500 mg/dL while on background statin therapy. In general, treatment with EPA+DHA appears to lower patient triglycerides more effectively, but in those patients with very high triglyceride levels, use of EPA+DHA also raised low-density lipoprotein cholesterol levels, whereas EPA alone did not. Both formulations, at doses that do not lower triglycerides, have been shown to reduce CVD events in some, but not all, studies. Given the favorable risk-to-benefit ratio for these essentially nutritional agents, use is expected to continue to expand.
鱼油中的 omega-3 脂肪酸（FA），即二十碳五烯酸（EPA）和二十二碳六烯酸（DHA），已在多种疾病的治疗中进行了广泛的研究，但在心血管疾病（CVD）中的研究最为广泛。我们的综述总结了作用机制、最近 CVD 结局试验的荟萃分析、来源（鱼类和补充剂）以及在临床实践中使用 omega-3 FA 的建议。由于现在可以通过血液测试来衡量 omega-3 FA 的生物状态，患者可以通过服用鱼油补充剂或简单地多吃油性鱼类来达到心脏保护水平。两种 omega-3 FA 制剂（均为乙酯形式）已被美国食品和药物管理局（FDA）批准用于治疗甘油三酯水平非常高（> 500mg/dL）的患者；一种制剂含有 EPA 和 DHA，另一种制剂仅含有 EPA。这些药物已在两种患者群体中进行了广泛的测试，一种是甘油三酯非常高的患者，另一种是在背景他汀类药物治疗下甘油三酯在 200 至 500mg/dL 之间的患者。一般来说，用 EPA+DHA 治疗似乎能更有效地降低患者的甘油三酯水平，但在甘油三酯水平非常高的患者中，用 EPA+DHA 治疗还会升高低密度脂蛋白胆固醇水平，而单用 EPA 则不会。两种制剂在不降低甘油三酯的剂量下，已被证明能在某些但不是所有研究中降低 CVD 事件的发生。鉴于这些基本营养药物的风险效益比有利，预计其使用将继续扩大。
