Alexander Dominik D, Miller Paige E, Van Elswyk Mary E, Kuratko Connye N, Bylsma Lauren C
Department of Epidemiology, EpidStat Institute, Ann Arbor, MI.
Nutrition and Food Services, Edward Hines Jr VA Hospital, Hines, IL.
Mayo Clin Proc. 2017 Jan;92(1):15-29. doi: 10.1016/j.mayocp.2016.10.018.
To conduct meta-analyses of randomized controlled trials (RCTs) to estimate the effect of eicosapentaenoic and docosahexaenoic acid (EPA+DHA) on coronary heart disease (CHD), and to conduct meta-analyses of prospective cohort studies to estimate the association between EPA+DHA intake and CHD risk.
A systematic literature search of Ovid/Medline, PubMed, Embase, and the Cochrane Library from January 1, 1947, to November 2, 2015, was conducted; 18 RCTs and 16 prospective cohort studies examining EPA+DHA from foods or supplements and CHD, including myocardial infarction, sudden cardiac death, coronary death, and angina, were identified. Random-effects meta-analysis models were used to generate summary relative risk estimates (SRREs) and 95% CIs. Heterogeneity was examined in subgroup and sensitivity analyses and by meta-regression. Dose-response was evaluated in stratified dose or intake analyses. Publication bias assessments were performed.
Among RCTs, there was a nonstatistically significant reduction in CHD risk with EPA+DHA provision (SRRE=0.94; 95% CI, 0.85-1.05). Subgroup analyses of data from RCTs indicated a statistically significant CHD risk reduction with EPA+DHA provision among higher-risk populations, including participants with elevated triglyceride levels (SRRE=0.84; 95% CI, 0.72-0.98) and elevated low-density lipoprotein cholesterol (SRRE=0.86; 95% CI, 0.76-0.98). Meta-analysis of data from prospective cohort studies resulted in a statistically significant SRRE of 0.82 (95% CI, 0.74-0.92) for higher intakes of EPA+DHA and risk of any CHD event.
Results indicate that EPA+DHA may be associated with reducing CHD risk, with a greater benefit observed among higher-risk populations in RCTs.
进行随机对照试验（RCT）的荟萃分析，以评估二十碳五烯酸和二十二碳六烯酸（EPA+DHA）对冠心病（CHD）的影响，并进行前瞻性队列研究的荟萃分析，以评估EPA+DHA摄入量与CHD风险之间的关联。
对1947年1月1日至2015年11月2日期间的Ovid/Medline、PubMed、Embase和Cochrane图书馆进行系统文献检索；确定了18项RCT和16项前瞻性队列研究，这些研究考察了来自食物或补充剂的EPA+DHA与CHD（包括心肌梗死、心源性猝死、冠心病死亡和心绞痛）之间的关系。采用随机效应荟萃分析模型生成汇总相对风险估计值（SRRE）和95%置信区间（CI）。在亚组分析、敏感性分析和Meta回归中检查异质性。在分层剂量或摄入量分析中评估剂量反应。进行发表偏倚评估。
在RCT中，提供EPA+DHA使CHD风险有非统计学意义的降低（SRRE=0.94；95%CI，0.85-1.05）。RCT数据的亚组分析表明，在高危人群中，包括甘油三酯水平升高的参与者（SRRE=0.84；CI，0.72-0.98）和低密度脂蛋白胆固醇升高的参与者（SRRE=0.86；95%CI，0.76-0.98），提供EPA+DHA可使CHD风险有统计学意义的降低。对前瞻性队列研究数据的荟萃分析显示，较高摄入量的EPA+DHA与任何CHD事件风险之间的SRRE有统计学意义，为0.82（95%CI，0.74-0.92）。
结果表明，EPA+DHA可能与降低CHD风险有关，在RCT的高危人群中观察到更大的益处。
