Department of Cardiology, Mount Sinai Beth Israel, New York, NY.
Department of Cardiology, Case Western Reserve University, Metrohealth, Cleveland, Ohio.
Am J Med. 2019 Oct;132(10):1153-1159. doi: 10.1016/j.amjmed.2019.04.027. Epub 2019 May 8.
Fatty acids derived from fish oil are long-chain omega-3 (n-3) polyunsaturated fatty acids. The important polyunsaturated fatty acids of fish oil are eicosapentaenoic acid, and docosahexaenoic acid. For decades, there has been a debate about the use of omega-3 fatty acids and their benefits on cardiovascular health. The more recent trials including the JELIS, VITAL, STRENGTH, and ASCEND trials, addressed the paucity of data of omega-3 fatty acids on primary and secondary prevention of cardiovascular events and the risk-benefit balance of these supplements. Prior to these studies, many large randomized controlled trials have shown conflicting results on the effect of polyunsaturated fatty acids in patients with prior coronary artery disease, stroke, or major vascular events. These inconsistent results warrant a better understanding of the effects of omega-3 fatty acids on the subtypes of cardiovascular diseases, and their use in primary and secondary prevention. More recently, icosapent ethyl showed a significant reduction in cardiovascular mortality and ischemic events in patients with elevated triglyceride (TG) and established cardiovascular disease or diabetes. The REDUCE-IT trial paved the way to further reduce cardiovascular risk in patients with high TG despite being on a maximally tolerated statin. The aim of this review is to discuss these recent updates on the use of various forms of fish oil, including prescription form and supplement in cardiometabolic diseases, and their surrounding controversies.
鱼油衍生的脂肪酸是长链ω-3（n-3）多不饱和脂肪酸。鱼油中重要的多不饱和脂肪酸有二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）。几十年来，一直存在关于ω-3 脂肪酸的使用及其对心血管健康益处的争论。最近的试验包括 JELIS、VITAL、STRENGTH 和 ASCEND 试验，解决了缺乏关于ω-3 脂肪酸在心血管事件一级和二级预防中的数据，以及这些补充剂的风险-效益平衡问题。在这些研究之前，许多大型随机对照试验已经表明，多不饱和脂肪酸对既往有冠状动脉疾病、中风或主要血管事件的患者的影响存在相互矛盾的结果。这些不一致的结果需要更好地了解 ω-3 脂肪酸对心血管疾病亚型的影响，以及它们在一级和二级预防中的应用。最近，icosapent ethyl 显示在患有高甘油三酯（TG）和已确诊心血管疾病或糖尿病的患者中，心血管死亡率和缺血性事件显著减少。REDUCE-IT 试验为在最大耐受他汀类药物治疗的基础上进一步降低高 TG 患者的心血管风险铺平了道路。本文的目的是讨论这些关于各种形式的鱼油（包括处方形式和补充剂）在心脏代谢疾病中的应用的最新进展，以及它们周围的争议。
