补充微量营养素以降低心血管疾病风险。

Micronutrient Supplementation to Reduce Cardiovascular Risk.

作者信息

An Peng, Wan Sitong, Luo Yongting, Luo Junjie, Zhang Xu, Zhou Shuaishuai, Xu Teng, He Jingjing, Mechanick Jeffrey I, Wu Wen-Chih, Ren Fazheng, Liu Simin

机构信息

Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food Quality, China Agricultural University, Beijing, China.

Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

出版信息

J Am Coll Cardiol. 2022 Dec 13;80(24):2269-2285. doi: 10.1016/j.jacc.2022.09.048.

DOI:10.1016/j.jacc.2022.09.048

PMID:36480969

Abstract

BACKGROUND

Healthy dietary patterns are rich in micronutrients, but their influence on cardiovascular disease (CVD) risks has not been systematically quantified.

OBJECTIVES

The goal of this study was to provide a comprehensive and most up-to-date evidence-based map that systematically quantifies the impact of micronutrients on CVD outcomes.

METHODS

This study comprised a systematic review and meta-analysis of randomized controlled intervention trials of micronutrients on CVD risk factors and clinical events.

RESULTS

A total of 884 randomized controlled intervention trials evaluating 27 types of micronutrients among 883,627 participants (4,895,544 person-years) were identified. Supplementation with n-3 fatty acid, n-6 fatty acid, l-arginine, l-citrulline, folic acid, vitamin D, magnesium, zinc, α-lipoic acid, coenzyme Q10, melatonin, catechin, curcumin, flavanol, genistein, and quercetin showed moderate- to high-quality evidence for reducing CVD risk factors. Specifically, n-3 fatty acid supplementation decreased CVD mortality (relative risk [RR]: 0.93; 95% CI: 0.88-0.97), myocardial infarction (RR: 0.85; 95% CI: 0.78-0.92), and coronary heart disease events (RR: 0.86; 95% CI: 0.80-0.93). Folic acid supplementation decreased stroke risk (RR: 0.84; 95% CI: 0.72-0.97), and coenzyme Q10 supplementation decreased all-cause mortality events (RR: 0.68; 95% CI: 0.49-0.94). Vitamin C, vitamin D, vitamin E, and selenium showed no effect on CVD or type 2 diabetes risk. β-carotene supplementation increased all-cause mortality (RR: 1.10; 95% CI: 1.05-1.15), CVD mortality events (RR: 1.12; 95% CI: 1.06-1.18), and stroke risk (RR: 1.09; 95% CI: 1.01-1.17).

CONCLUSIONS

Supplementation of some but not all micronutrients may benefit cardiometabolic health. This study highlights the importance of micronutrient diversity and the balance of benefits and risks to promote and maintain cardiovascular health in diverse populations. (Antioxidant Supplementation in the Prevention and Treatment of Cardiovascular Diseases; CRD42022315165).

摘要

背景

健康的饮食模式富含微量营养素，但其对心血管疾病（CVD）风险的影响尚未得到系统量化。

目的

本研究的目的是提供一份全面且最新的循证图谱，系统地量化微量营养素对心血管疾病结局的影响。

方法

本研究包括对微量营养素对心血管疾病风险因素和临床事件的随机对照干预试验进行系统评价和荟萃分析。

结果

共确定了884项随机对照干预试验，评估了883,627名参与者（4,895,544人年）中的27种微量营养素。补充n-3脂肪酸、n-6脂肪酸、L-精氨酸、L-瓜氨酸、叶酸、维生素D、镁、锌、α-硫辛酸、辅酶Q10、褪黑素、儿茶素、姜黄素、黄烷醇、染料木黄酮和槲皮素显示出降低心血管疾病风险因素的中高质量证据。具体而言，补充n-3脂肪酸可降低心血管疾病死亡率（相对风险[RR]：0.93；95%置信区间：0.88-0.97）、心肌梗死（RR：0.85；95%置信区间：0.78-0.92）和冠心病事件（RR：0.86；95%置信区间：0.80-0.93）。补充叶酸可降低中风风险（RR：0.84；95%置信区间：0.72-0.97），补充辅酶Q10可降低全因死亡事件（RR：0.68；95%置信区间：0.49-0.94）。维生素C、维生素D、维生素E和硒对心血管疾病或2型糖尿病风险无影响。补充β-胡萝卜素会增加全因死亡率（RR：1.10；95%置信区间：1.05-1.15）、心血管疾病死亡事件（RR：1.12；95%置信区间：1.06-1.18）和中风风险（RR：1.09；95%置信区间：1.01-1.17）。