Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Cardiology Division, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States.
Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, United States.
Prostaglandins Leukot Essent Fatty Acids. 2021 Jun;169:102283. doi: 10.1016/j.plefa.2021.102283. Epub 2021 Apr 24.
The roles of omega-3 (n3) fatty acids [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] and low-dose aspirin in the primary prevention of ischemic cardiovascular disease (CVD) are controversial. Since omega-3 (n3) fatty acids and aspirin affect cyclooxygenase activity in platelets, there could be a clinically-relevant effect of aspirin combined with a particular n3 fatty acid level present in each individual.
RBC EPA+DHA, arachidonic acid (AA) and docosapentaenoic acid (DPA) were measured in 2500 participants without known CVD in the Framingham Heart Study. We then tested for interactions with reported aspirin use (1004 reported use and 1494 did not) on CVD outcomes. The median follow-up was 7.2 years.
Having RBC EPA+DHA in the second quintile (4.2-4.9% of total fatty acids) was associated with significantly reduced risk for future CVD events (relative to the first quintile, <4.2%) in those who did not take aspirin (HR 0.54 (0.30, 0.98)), but in those reporting aspirin use, risk was significantly increased (HR 2.16 (1.19, 3.92)) in this quintile. This interaction remained significant when adjusting for confounders. Significant interactions were also present for coronary heart disease and stroke outcomes using the same quintiles. Similar findings were present for EPA and DHA alone but not for DPA and AA.
There is a complex interaction between aspirin use and RBC EPA+DHA levels on CVD outcomes. This suggests that aspirin use may be beneficial in one omega-3 environment but harmful in another, implying that a personalized approach to both aspirin use and omega-3 supplementation may be needed.
ω-3（n-3）脂肪酸[二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）]和小剂量阿司匹林在缺血性心血管疾病（CVD）的一级预防中的作用存在争议。由于 ω-3（n-3）脂肪酸和阿司匹林会影响血小板中环氧化酶的活性，因此在个体中存在特定的 n-3 脂肪酸水平与阿司匹林联合使用可能会产生临床相关的影响。
在弗雷明汉心脏研究中，对 2500 名无已知 CVD 的参与者的 RBC EPA+DHA、花生四烯酸（AA）和二十二碳五烯酸（DPA）进行了测量。然后，我们检测了报告的阿司匹林使用情况（1004 例报告使用和 1494 例未使用）与 CVD 结局之间的相互作用。中位随访时间为 7.2 年。
在未服用阿司匹林的人群中，RBC EPA+DHA 处于第二五分位数（总脂肪酸的 4.2-4.9%）与未来 CVD 事件的风险显著降低相关（与第一五分位数相比，<4.2%）（HR 0.54（0.30，0.98）），但在报告使用阿司匹林的人群中，在这五分位数中，风险显著增加（HR 2.16（1.19，3.92））。在调整混杂因素后，这种相互作用仍然显著。使用相同五分位数，也存在冠心病和卒中结局的显著交互作用。对于 EPA 和 DHA 单独存在相似的发现，但对于 DPA 和 AA 则没有。
阿司匹林使用与 RBC EPA+DHA 水平对 CVD 结局之间存在复杂的相互作用。这表明，在一种 ω-3 环境中，阿司匹林的使用可能是有益的，但在另一种环境中则可能是有害的，这表明可能需要对阿司匹林使用和 ω-3 补充剂采用个性化的方法。
