Davidson Michael H, Benes Lane B
Department of Medicine, Section of Cardiology, The University of Chicago, Chicago, Illinois, USA.
Curr Opin Lipidol. 2016 Dec;27(6):570-578. doi: 10.1097/MOL.0000000000000353.
This article focuses on the potential role by which a complex mixture of omega-3 fatty acids (OM3-FAs) may beneficially modify cardiovascular risk by modifying the cholesterol composition of atherogenic lipoproteins. This hypothesis is being tested in the STRENGTH trial, which is enrolling 13 000 patients on statins at high cardiovascular risk with hypertriglyceridemia and low HDL cholesterol (HDL-C) treated with an OM3-carboxylic acid.
Complex mixtures of OM3-FAs containing predominately eicosapentanoic acid and docosahexanoic acid in combination with statins lowers non-HDL by reducing triglyceride-rich lipoprotein cholesterol (TRL-C) while shifting small LDL cholesterol (LDL-C) to large LDL-C. Recent genomic and epidemiological studies have implicated TRL-C and small LDL-C as causal for cardiovascular disease. Therefore OM3-FAs containing both eicosapentanoic acid and docosahexanoic acid in combination with statins may beneficially modify the high residual risk for patients with hypertriglyceridemia and low HDL-C.
Although outcome trials are underway, subgroup analyses of data from previous randomized controlled trials are suggestive of a reduction in coronary artery disease and atherosclerotic cardiovascular disease event rates with triglyceride and TRL-C lowering therapies, particularly if accompanied by low HDL-C. Although the limitations of such data are acknowledged, clinicians must make treatment decisions while awaiting more definitive results from well-designed large-scale randomized controlled trials.
本文重点关注ω-3脂肪酸（OM3-FAs）的复杂混合物通过改变致动脉粥样硬化脂蛋白的胆固醇组成，可能对心血管风险产生有益影响的潜在作用。这一假设正在“增强（STRENGTH）试验”中进行验证，该试验正在招募13000名服用他汀类药物、心血管风险高、患有高甘油三酯血症且高密度脂蛋白胆固醇（HDL-C）低的患者，给予一种OM3-羧酸进行治疗。
主要包含二十碳五烯酸和二十二碳六烯酸的OM3-FAs复杂混合物与他汀类药物联合使用，可通过降低富含甘油三酯的脂蛋白胆固醇（TRL-C）来降低非HDL，同时将小颗粒低密度脂蛋白胆固醇（LDL-C）转变为大颗粒LDL-C。最近的基因组学和流行病学研究表明，TRL-C和小颗粒LDL-C是心血管疾病的病因。因此，同时含有二十碳五烯酸和二十二碳六烯酸的OM3-FAs与他汀类药物联合使用，可能对高甘油三酯血症和低HDL-C患者的高残余风险产生有益影响。
尽管正在进行结果试验，但对先前随机对照试验数据的亚组分析表明，降低甘油三酯和TRL-C的治疗方法，尤其是在伴有低HDL-C的情况下，可降低冠状动脉疾病和动脉粥样硬化性心血管疾病的事件发生率。尽管认识到这些数据存在局限性，但临床医生在等待精心设计的大规模随机对照试验得出更明确的结果时，必须做出治疗决策。
