FACT (French Alliance for Cardiovascular Trials), Paris, France.
Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France.
Curr Atheroscler Rep. 2021 Mar 31;23(6):27. doi: 10.1007/s11883-021-00919-2.
This reviews aims to evaluate the role of omega-3 for cardiovascular disease (CVD) risk reduction in mild-moderate hypertriglyceridemia.
Epidemiological and Mendelian randomization studies have demonstrated that hypertriglyceridemia is strongly correlated to CVD. Even in patients with optimal low-density lipoprotein cholesterol (LDL-C) levels, triglycerides remain an important predictor to lower residual cardiovascular risk. In addition to screening, lifestyle intervention, and LDL-C lowering with statins for hypercholesterolemia (and other agents if needed), additional pharmacological therapies may be indicated to lower residual CVD risk in patients with persistent elevated triglyceride levels. Low-dose combinations of eicosapentaenoic acid (EPA) and docosahexaenoic acid have failed to reduce CVD in primary prevention. A recent trial evaluating high-dose purified EPA (icosapent ethyl) in mild-moderate hypertriglyceridemic statin-treated patients with or at high-risk atherosclerotic CVD demonstrated a clear benefit on cardiovascular outcomes. The recent REDUCE-IT trial shed light on omega-3 therapy. High-dose icosapent ethyl, a highly purified ethyl ester of EPA, reduced the risk of CVD events in statin-treated hypertriglyceridemic patients at elevated cardiovascular risk. Therefore, omega-3 therapy using high-dose icosapent ethyl should be recommended in statin-treated high-risk patients at high residual CVD risk and mild to moderate elevation of triglycerides. While icosapent ethyl demonstrated a benefit in these patients, drug class effect cannot be assumed and further investigations are warranted to examine the effects of other omega-3 agents at high doses.
目的综述： 本综述旨在评估 ω-3 脂肪酸在降低轻中度高甘油三酯血症患者心血管疾病（CVD）风险方面的作用。
新发现： 流行病学和孟德尔随机化研究表明，高甘油三酯血症与 CVD 密切相关。即使在 LDL-C 水平最佳的患者中，甘油三酯仍然是降低残余心血管风险的重要预测指标。除了筛查、生活方式干预和他汀类药物降低高胆固醇血症（如有必要，还可使用其他药物）外，对于持续升高的甘油三酯水平的患者，可能需要额外的药物治疗来降低残余 CVD 风险。低剂量的二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）联合治疗未能降低一级预防中的 CVD 风险。最近一项评估高剂量纯化 EPA（icosapent ethyl）在他汀类药物治疗的轻中度高甘油三酯血症且伴有或有高 ASCVD 风险的患者中的疗效的试验显示，心血管结局有明显获益。最近的 REDUCE-IT 试验揭示了 ω-3 疗法的相关信息。高剂量的icosapent ethyl（EPA 的高度纯化乙酯）降低了 ASCVD 风险升高的他汀类药物治疗的高甘油三酯血症患者的 CVD 事件风险。因此，对于他汀类药物治疗的高风险患者，在残余 CVD 风险高且甘油三酯轻度至中度升高时，应推荐使用高剂量的icosapent ethyl 进行 ω-3 治疗。虽然icosapent ethyl 在这些患者中显示出获益，但不能假设药物类别效应，还需要进一步的研究来检查其他高剂量 ω-3 药物的效果。
