Nishizaki Yuji, Daida Hiroyuki
Medical Technology Innovation Center, Juntendo University Tokyo Japan.
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine Tokyo Japan.
Circ Rep. 2020 Mar 28;2(4):260-264. doi: 10.1253/circrep.CR-20-0012.
The n-3 polyunsaturated fatty acids (PUFA), represented by eicosapentaenoic acid (EPA) and docosahexaenoic acid, have anti-atherogenic effects (e.g., neutral fat-lowering effects) and other beneficial effects such as antiplatelet, anti-inflammatory, plaque stabilizing, vascular endothelial function ameliorative, antihypertensive, and anti-arrhythmic effects. Epidemiological studies and clinical trials have assessed the inhibitory effects of n-3 PUFA on cardiovascular events. Studies that reported positive outcomes, such as the Japan EPA Lipid intervention Study (JELIS) and the Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia (REDUCE-IT), noted a tendency toward the use of high-dose n-3 PUFA (1.8-4 g/day). The Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Prevenzione (GISSI-Prevenzione) trial and the JELIS had high EPA/arachidonic acid (AA) baseline ratios. In contrast, negative outcome studies, such as the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial, Risk and Prevention study, A Study of Cardiovascular Events in Diabetes (ASCEND), and the Vitamin D and Omega-3 Trial (VITAL) had participants who tended to use low-dose n-3 PUFA (0.84-1 g/day) and to have low baseline EPA/AA. Differences in baseline EPA/AA ratio and the EPA/AA ratio threshold for the prevention of cardiovascular events seem to contribute to the different outcomes, together with the dose of n-3 PUFA.
以二十碳五烯酸（EPA）和二十二碳六烯酸为代表的n-3多不饱和脂肪酸（PUFA）具有抗动脉粥样硬化作用（如降低中性脂肪的作用）以及其他有益作用，如抗血小板、抗炎、稳定斑块、改善血管内皮功能、降压和抗心律失常作用。流行病学研究和临床试验评估了n-3 PUFA对心血管事件的抑制作用。报告了积极结果的研究，如日本EPA脂质干预研究（JELIS）和二十碳五烯酸乙酯降低高甘油三酯血症患者心血管风险研究（REDUCE-IT），指出有使用高剂量n-3 PUFA（1.8 - 4克/天）的趋势。意大利心肌梗死存活研究组 - 预防研究（GISSI-Prevenzione）试验和JELIS试验的基线EPA/花生四烯酸（AA）比值较高。相比之下，结果为阴性的研究，如甘精胰岛素初始干预降低结局研究（ORIGIN）试验、风险与预防研究、糖尿病心血管事件研究（ASCEND）以及维生素D和Omega-3试验（VITAL），其参与者倾向于使用低剂量n-3 PUFA（0.84 - 1克/天）且基线EPA/AA较低。基线EPA/AA比值以及预防心血管事件的EPA/AA比值阈值的差异，连同n-3 PUFA的剂量，似乎导致了不同的结果。
