Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang-si, South Korea.
Division of Cardiovascular Disease, Gachon University Gil Hospital, Incheon, South Korea; Gachon Cardiovascular Research Institute, Incheon, South Korea.
Atherosclerosis. 2021 Apr;322:15-23. doi: 10.1016/j.atherosclerosis.2021.02.014. Epub 2021 Feb 23.
Omega-3 fatty acids have emerged as a new option for controlling the residual risk for cardiovascular disease (CVD) in the statin era after a clinical trial (REDUCE-IT) reported positive results with icosapent ethyl (IPE) in patients receiving maximally tolerated statin therapy. However, another trial which used high dose eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) combination (STRENGTH) has failed. Together, these results raise clinically important questions. Are effects of omega-3 fatty acids neutral or beneficial in patients on statin therapy, or perhaps even harmful? The current contradictory results could be attributed to different types of omega-3 fatty acids (only EPA or combination of EPA + DHA), doses (higher vs. lower dose) of omega-3 fatty acids or different comparators (corn oil or mineral oil), as well as the underlying severity of the CVD risk or use of statins. Together with these issues, we will discuss different biological and clinical effects of various types of omega-3 fatty acids and then interpret different results of past and current clinical studies and propose practical suggestions, which could be applied in patient management.
ω-3 脂肪酸在他汀类药物时代控制心血管疾病（CVD）残余风险方面出现了新的选择，此前一项临床试验（REDUCE-IT）报告了在接受最大耐受剂量他汀类药物治疗的患者中，icosapent ethyl（IPE）具有阳性结果。然而，另一项使用高剂量二十碳五烯酸（EPA）+二十二碳六烯酸（DHA）联合治疗的试验（STRENGTH）失败了。这些结果共同提出了临床上重要的问题。ω-3 脂肪酸对接受他汀类药物治疗的患者的影响是中性的还是有益的，或者甚至是有害的？目前相互矛盾的结果可能归因于不同类型的 ω-3 脂肪酸（仅 EPA 或 EPA+DHA 的组合）、ω-3 脂肪酸的剂量（高剂量与低剂量）或不同的对照剂（玉米油或矿物油），以及潜在的 CVD 风险严重程度或他汀类药物的使用。结合这些问题，我们将讨论不同类型的 ω-3 脂肪酸的不同生物学和临床作用，然后解释过去和当前临床研究的不同结果，并提出实际建议，这些建议可应用于患者管理。
