Division of Cardiology Vienna General HospitalMedical University of Vienna Austria.
TIMI Study Group Division of Cardiovascular Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA.
J Am Heart Assoc. 2021 Apr 20;10(8):e017401. doi: 10.1161/JAHA.120.017401. Epub 2021 Apr 12.
Background Plasma omega-3 polyunsaturated fatty acids (ω3-PUFAs) have been shown to be inversely correlated with the risk of cardiovascular death in primary prevention. The risk relationship in the setting of an acute coronary syndrome is less well established. Methods and Results Baseline plasma ω3-PUFA composition (α-linolenic acid, eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid) was assessed through gas chromatography with flame ionization detection in a case-cohort study involving 203 patients with cardiovascular death, 325 with myocardial infarction, 271 with ventricular tachycardia, and 161 with atrial fibrillation, and a random sample of 1612 event-free subjects as controls from MERLIN-TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation-Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36), a trial of patients hospitalized with non-ST-segment-elevation -acute coronary syndrome. After inverse-probability-weighted multivariable adjustment including all traditional risk factors, a higher relative proportion of long-chain ω3-PUFAs (eicosapentaenoic acid, docosapentaenoic acid, docosahexaenoic acid) were associated with 18% lower odds of cardiovascular death (adjusted [adj] odds ratio [OR] per 1 SD, 0.82; 95% CI, 0.68-0.98) that was primarily driven by 27% lower odds of sudden cardiac death (adj OR per 1 SD, 0.73; 95% CI, 0.55-0.97). Long-chain ω3-PUFA levels in the top quartile were associated with 51% lower odds of cardiovascular death (adj OR 0.49; 95% CI, 0.27-0.86) and 63% lower odds of sudden cardiac death (adj OR, 0.37; 95% CI, 0.16-0.56). An attenuated relationship was seen for α-linolenic acid and subsequent odds of cardiovascular (adj OR, 0.92; 95% CI, 0.74-1.14) and sudden cardiac death (adj OR, 0.91; 95% CI, 0.67-1.25). No significant relationship was observed between any ω3-PUFAs and the odds of cardiovascular death unrelated to sudden cardiac death, myocardial infarction, atrial fibrillation, or early post-acute coronary syndrome ventricular tachycardia. Conclusions In patients after non-ST-segment-elevation-acute coronary syndrome, plasma long-chain ω3-PUFAs are inversely associated with lower odds of sudden cardiac death, independent of traditional risk factors and lipids. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00099788.
血浆ω-3 多不饱和脂肪酸（ω3-PUFAs）与一级预防中心血管死亡风险呈负相关。在急性冠状动脉综合征（acute coronary syndrome，ACS）患者中，这种风险关系尚未得到充分证实。
在 MERLIN-TIMI 36（Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation-Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36，用雷诺嗪降低非 ST 段抬高型急性冠状动脉综合征患者缺血代谢效率试验）中，通过气相色谱-火焰离子化检测，对 203 例心血管死亡患者、325 例心肌梗死患者、271 例室性心动过速患者、271 例室性心动过速患者及 1612 例无事件的随机样本（对照组）的基线血浆 ω3-PUFA 组成（α-亚麻酸、二十碳五烯酸、二十二碳五烯酸和二十二碳六烯酸）进行评估。这是一项针对非 ST 段抬高型急性冠状动脉综合征患者住院患者的试验。在进行逆概率加权多变量调整（包括所有传统危险因素）后，长链 ω3-PUFAs（二十碳五烯酸、二十二碳五烯酸、二十二碳六烯酸）的相对比例较高与心血管死亡风险降低 18%相关（每 1 SD 的调整[adj]比值比[OR]，0.82；95%CI，0.68-0.98），这主要归因于心脏性猝死风险降低 27%（每 1 SD 的 adj OR，0.73；95%CI，0.55-0.97）。长链 ω3-PUFA 水平处于最高四分位数时，与心血管死亡风险降低 51%相关（adj OR 0.49；95%CI，0.27-0.86），心脏性猝死风险降低 63%（adj OR，0.37；95%CI，0.16-0.56）。α-亚麻酸与心血管（adj OR，0.92；95%CI，0.74-1.14）和心脏性猝死（adj OR，0.91；95%CI，0.67-1.25）的发生几率之间的关系减弱。在非 ST 段抬高型急性冠状动脉综合征患者中，任何 ω3-PUFAs 与心血管死亡无关（与心脏性猝死、心肌梗死、心房颤动或 ACS 早期室性心动过速无关）的几率之间未观察到显著相关性。
在非 ST 段抬高型急性冠状动脉综合征患者中，血浆长链 ω3-PUFAs 与较低的心脏性猝死风险呈负相关，独立于传统危险因素和脂质。
