Siscovick David S, Barringer Thomas A, Fretts Amanda M, Wu Jason H Y, Lichtenstein Alice H, Costello Rebecca B, Kris-Etherton Penny M, Jacobson Terry A, Engler Mary B, Alger Heather M, Appel Lawrence J, Mozaffarian Dariush
Circulation. 2017 Apr 11;135(15):e867-e884. doi: 10.1161/CIR.0000000000000482. Epub 2017 Mar 13.
Multiple randomized controlled trials (RCTs) have assessed the effects of supplementation with eicosapentaenoic acid plus docosahexaenoic acid (omega-3 polyunsaturated fatty acids, commonly called fish oils) on the occurrence of clinical cardiovascular diseases. Although the effects of supplementation for the primary prevention of clinical cardiovascular events in the general population have not been examined, RCTs have assessed the role of supplementation in secondary prevention among patients with diabetes mellitus and prediabetes, patients at high risk of cardiovascular disease, and those with prevalent coronary heart disease. In this scientific advisory, we take a clinical approach and focus on common indications for omega-3 polyunsaturated fatty acid supplements related to the prevention of clinical cardiovascular events. We limited the scope of our review to large RCTs of supplementation with major clinical cardiovascular disease end points; meta-analyses were considered secondarily. We discuss the features of available RCTs and provide the rationale for our recommendations. We then use existing American Heart Association criteria to assess the strength of the recommendation and the level of evidence. On the basis of our review of the cumulative evidence from RCTs designed to assess the effect of omega-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events, we update prior recommendations for patients with prevalent coronary heart disease, and we offer recommendations, when data are available, for patients with other clinical indications, including patients with diabetes mellitus and prediabetes and those with high risk of cardiovascular disease, stroke, heart failure, and atrial fibrillation.
多项随机对照试验（RCT）评估了补充二十碳五烯酸加二十二碳六烯酸（ω-3多不饱和脂肪酸，通常称为鱼油）对临床心血管疾病发生的影响。虽然尚未研究补充剂对普通人群临床心血管事件一级预防的效果，但RCT评估了补充剂在糖尿病和糖尿病前期患者、心血管疾病高危患者以及患有冠心病的患者二级预防中的作用。在本科学咨询中，我们采用临床方法，重点关注与预防临床心血管事件相关的ω-3多不饱和脂肪酸补充剂的常见适应证。我们将综述范围限制在以主要临床心血管疾病终点为补充剂的大型RCT；其次考虑荟萃分析。我们讨论现有RCT的特点，并提供我们建议的理由。然后，我们使用美国心脏协会现有的标准来评估建议的强度和证据水平。基于我们对旨在评估ω-3多不饱和脂肪酸补充剂对临床心血管事件影响的RCT累积证据的综述，我们更新了对患有冠心病患者的先前建议，并在有数据时为具有其他临床适应证的患者提供建议，包括糖尿病和糖尿病前期患者以及心血管疾病、中风、心力衰竭和心房颤动高危患者。
