LMC Diabetes & Endocrinology, Concord, Ontario.
Division of Endocrinology and Metabolism, St Michael's Hospital of Unity Health Toronto, Toronto, Ontario.
Curr Opin Cardiol. 2021 Sep 1;36(5):661-671. doi: 10.1097/HCO.0000000000000873.
Elevated levels of triglycerides, independent of low-density lipoprotein cholesterol (LDL-C) levels and statin therapy, are associated with heightened cardiovascular risk.
Mixed omega-3 fatty acid formulations, which contain varying amounts of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), lower triglycerides levels but trial results with omega-3 fatty acids combinations have generally been neutral for cardiovascular outcomes. In contrast, the REDUCE-IT trial with icosapent ethyl (IPE), a highly purified ethyl ester of EPA, demonstrated reduced cardiovascular risk in individuals with established atherosclerotic cardiovascular disease or diabetes with at least one additional risk factor, despite having relatively well controlled LDL-C levels but triglycerides at least 135 mg/dl while on statin therapy. IPE offers an important new avenue for cardiovascular risk management in statin-treated individuals with elevated triglycerides.
This review summarizes the results from outcome trials conducted with omega-3 fatty acids, differentiating between those with combinations of EPA/DHA and those with pure EPA, as well as imaging and preclinical data that help explain the different cardiovascular efficacy observed. A list of frequently asked questions with evidence-based responses is provided to assist our colleagues and their patients in the shared-decision process when considering if IPE is appropriate for cardiovascular risk reduction.
甘油三酯水平升高，独立于低密度脂蛋白胆固醇（LDL-C）水平和他汀类药物治疗，与心血管风险增加相关。
混合ω-3 脂肪酸制剂含有不同量的二十二碳六烯酸（DHA）和二十碳五烯酸（EPA），可降低甘油三酯水平，但ω-3 脂肪酸联合治疗的试验结果通常对心血管结局无影响。相比之下，REDUCE-IT 试验中使用高度纯化的二十碳五烯酸乙酯（IPE）治疗已确诊动脉粥样硬化性心血管疾病或糖尿病且至少存在一个其他危险因素的患者，可降低心血管风险，尽管这些患者 LDL-C 水平得到了较好的控制，但在他汀类药物治疗时甘油三酯至少为 135mg/dl。IPE 为他汀类药物治疗后甘油三酯升高的患者的心血管风险管理提供了一条重要的新途径。
本综述总结了用 ω-3 脂肪酸进行的结局试验结果，区分了 EPA/DHA 联合制剂和纯 EPA 制剂，并介绍了有助于解释观察到的不同心血管疗效的影像学和临床前数据。提供了一份常见问题解答清单，并附有基于证据的答案，以帮助我们的同事及其患者在考虑是否使用 IPE 降低心血管风险时进行共同决策。
