Burke Megan F, Burke Frances M, Soffer Daniel E
Department of Medicine, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Department of Medicine, Division of Cardiology, University of Pennsylvania Health System, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Curr Atheroscler Rep. 2017 Nov 7;19(12):60. doi: 10.1007/s11883-017-0700-z.
Populations with significant dietary fish intake tend to have lower cardiovascular (CV) risk and demonstrable physiologic differences including lower lipid/lipoprotein levels and other direct and indirect effects on the arterial wall and inhibiting factors that promote atherosclerosis. Treatment with high doses of pharmacologic-grade omega-3 fatty acid (n-3FA) supplements achieves significant reductions in triglycerides (TG), non-high-density lipoprotein- (non-HDL-) and TG-rich lipoprotein- (TRL-) cholesterol levels. n-3FA supplements have significant effects on markers of atherosclerosis risk including endothelial function, low-density lipoprotein (LDL) oxidation, cellular and humoral markers of inflammation, hemodynamic factors, and plaque stabilization. This review summarizes the lipid and cardiometabolic effects of prescription-grade n-3FAs and will discuss clinical trials, national/organizational guidelines, and expert opinion on the impact of supplemental n-3FAs on CV health and disease.
Clinical trial evidence supports use of n-3FAs in individuals with established atherosclerotic cardiovascular disease (ASCVD), but the data either does not support or is lacking for other types of cardiometabolic risk including prevention of stroke, treatment in patients with heart failure, diabetes mellitus and prediabetes, and for primary prevention in the general population. Despite inconsistent findings to support widespread benefit, there is persistent population-wide enthusiasm for n-3FA as a dietary supplement for its cardiometabolic benefits. Fortunately, there are ongoing clinical trials to assess whether the lipid/lipoprotein benefits may be extended to other at-risk populations and whether lower-dose therapy may provide background benefit for primary prevention of ASCVD.
大量摄入鱼类饮食的人群往往心血管（CV）风险较低，且存在明显的生理差异，包括较低的脂质/脂蛋白水平以及对动脉壁的其他直接和间接影响，同时还存在抑制动脉粥样硬化的因素。高剂量的药用级ω-3脂肪酸（n-3FA）补充剂治疗可显著降低甘油三酯（TG）、非高密度脂蛋白（non-HDL）和富含TG的脂蛋白（TRL）胆固醇水平。n-3FA补充剂对动脉粥样硬化风险标志物有显著影响，包括内皮功能、低密度脂蛋白（LDL）氧化、炎症的细胞和体液标志物、血流动力学因素以及斑块稳定。本综述总结了处方级n-3FAs的脂质和心脏代谢作用，并将讨论关于补充n-3FAs对CV健康和疾病影响的临床试验、国家/组织指南及专家意见。
临床试验证据支持在已确诊动脉粥样硬化性心血管疾病（ASCVD）的个体中使用n-3FAs，但对于其他类型的心脏代谢风险，包括预防中风、治疗心力衰竭、糖尿病和糖尿病前期患者以及一般人群的一级预防，数据要么不支持，要么缺乏。尽管支持广泛获益的研究结果不一致，但由于其心脏代谢益处，n-3FA作为膳食补充剂在人群中仍持续受到广泛欢迎。幸运的是，目前正在进行临床试验，以评估脂质/脂蛋白益处是否可扩展到其他高危人群，以及低剂量疗法是否可为ASCVD的一级预防提供背景益处。
