Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, Glen Ellyn, IL, USA.
Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, Glen Ellyn, IL, USA.
J Clin Lipidol. 2017 Sep-Oct;11(5):1152-1160.e2. doi: 10.1016/j.jacl.2017.07.010. Epub 2017 Aug 2.
Randomized controlled trials (RCTs) assessing use of long-chain omega-3 polyunsaturated fatty acids (LC-OM3), primarily eicosapentaenoic acid, and/or docosahexaenoic acid have shown mixed results.
The objectives of the study were to update and further explore the available RCT data regarding LC-OM3 supplementation and risk for cardiac death and to propose testable hypotheses for the mixed results obtained in RCTs regarding supplemental LC-OM3 use and cardiac risk.
A literature search was conducted using PubMed and Ovid/MEDLINE for RCTs assessing LC-OM3 supplements or pharmaceuticals with intervention periods of at least 6 months and reporting on the outcome of cardiac death. Meta-analysis was used to compare cumulative frequencies of cardiac death events between the LC-OM3 and control groups, including sensitivity and subset analyses.
Fourteen RCTs were identified for the primary analysis (71,899 subjects). In the LC-OM3 arms, 1613 cardiac deaths were recorded (4.48% of subjects), compared with 1746 cardiac deaths in the control groups (4.87% of subjects). The pooled relative risk estimate showed an 8.0% (95% confidence interval 1.6%, 13.9%, P = .015) lower risk in the LC-OM3 arms vs controls. Subset analyses showed numerically larger effects (12.9%-29.1% lower risks, all P < .05) in subsets of RCTs with eicosapentaenoic acid + docosahexaenoic acid dosages >1 g/d and higher risk samples (secondary prevention, baseline mean or median triglycerides ≥150 mg/dL, low-density lipoprotein cholesterol ≥130 mg/dL, statin use <40% of subjects). Heterogeneity was low (I ≤ 15.5%, P > .05) for the primary and subset analyses.
LC-OM3 supplementation is associated with a modest reduction in cardiac death.
评估长链欧米伽-3 多不饱和脂肪酸（LC-OM3），主要是二十碳五烯酸和/或二十二碳六烯酸使用的随机对照试验（RCT）显示出混合结果。
本研究的目的是更新和进一步探索关于 LC-OM3 补充剂与心脏死亡风险的现有 RCT 数据，并为 RCT 中关于补充 LC-OM3 使用与心脏风险的混合结果提出可检验的假设。
使用 PubMed 和 Ovid/MEDLINE 进行文献检索，检索评估 LC-OM3 补充剂或药物干预期至少 6 个月且报告心脏死亡结局的 RCT。使用荟萃分析比较 LC-OM3 组和对照组之间心脏死亡事件的累积频率，包括敏感性和亚组分析。
确定了 14 项主要分析 RCT（71899 例患者）。在 LC-OM3 组中，记录了 1613 例心脏死亡（占受试者的 4.48%），而对照组中记录了 1746 例心脏死亡（占受试者的 4.87%）。汇总的相对风险估计显示，LC-OM3 组的风险降低了 8.0%（95%置信区间 1.6%，13.9%，P =.015）。亚组分析显示，在 EPA+DHA 剂量大于 1 g/d 和高危样本（二级预防、基线平均或中位数三酰甘油≥150 mg/dL、低密度脂蛋白胆固醇≥130 mg/dL、他汀类药物使用率<40%的患者）的 RCT 亚组中，效果更大（风险降低 12.9%-29.1%，所有 P <.05）。主要和亚组分析的异质性较低（I ≤ 15.5%，P >.05）。
LC-OM3 补充剂与心脏死亡风险降低有关。
