Honorary Lecturer in the Department of Family Practice at the University of British Columbia in Vancouver.
Can Fam Physician. 2023 Jul;69(7):459-468. doi: 10.46747/cfp.6907459.
To explore the evidence for omega-3 fatty acid (O3FA) supplementation in primary and secondary prevention of cardiovascular disease (CVD).
PubMed, Cochrane reviews, and Google Scholar were searched for meta-analyses and reviews related to O3FAs and CVD. Salient, recent randomized controlled trials referenced in these reviews were retrieved. Current lipid guidelines were reviewed.
Most O3FAs are derived from marine or aquatic microalgae, which are consumed by fish. The essential fatty acids eicosapentaenoic acid and docosahexaenoic acid are mainly sourced from fish, with a small fraction coming from plants. Omega-3 fatty acids modestly lower triglyceride levels, but the major impact on CVD is through a variety of other mechanisms related to cell membrane function, antioxidant properties, and reduction of atherogenic small low-density lipoprotein cholesterol particles. Guidelines continue to recommend eating 2 servings of fish per week. There is little evidence of benefit of O3FAs in primary prevention of CVD. Given that 40% of Canadians have insufficient levels and that these low levels may be associated with other chronic diseases over time, supplementation with O3FAs could be considered, particularly in those with hypertriglyceridemia, in those who eat no fish, or for vegetarians or vegans. Doses up to 1 g daily are considered safe. For secondary prevention after statin optimization, if triglyceride levels are between 1.5 and 5.6 mmol/L, guidelines recommend with level 1A evidence taking 2 g of icosapent ethyl twice a day. This is also recommended in primary prevention for patients with diabetes and hypertriglyceridemia and additional CVD risk factors. As fish stocks dwindle over time, preserving fisheries for developing countries and obtaining O3FA from microalgal or genetically modified plant sources may become important.
All guidelines recommend at least 2 servings of oily fish per week, although benefit from O3FAs is mostly seen in secondary prevention. Fish oil and combination preparations of eicosapentaenoic acid and docosahexaenoic acid have failed to show benefit at any dose at any level of prevention in patients who are appropriately prescribed statins. High-dose eicosapentaenoic acid shows substantial benefit in selected patients taking statins who have high triglyceride levels.
探讨ω-3 脂肪酸（O3FA）补充剂在心血管疾病（CVD）一级和二级预防中的证据。
在 PubMed、Cochrane 综述和 Google Scholar 上搜索了与 O3FAs 和 CVD 相关的荟萃分析和综述。检索了这些综述中引用的最新随机对照试验。还查阅了现行的脂质指南。
大多数 O3FAs 来源于海洋或水生微藻，鱼类食用这些藻类。必需脂肪酸二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）主要来源于鱼类，一小部分来源于植物。ω-3 脂肪酸可适度降低甘油三酯水平，但对 CVD 的主要影响是通过细胞膜功能、抗氧化特性和减少致动脉粥样硬化的小而密低密度脂蛋白胆固醇颗粒等多种其他机制。指南继续建议每周食用 2 份鱼。O3FAs 在 CVD 一级预防中的益处证据有限。鉴于 40%的加拿大人摄入量不足，而且这些低水平可能随着时间的推移与其他慢性疾病有关，因此可以考虑补充 O3FAs，特别是在那些有高甘油三酯血症的人、那些不吃鱼的人、素食者或严格素食者。每日剂量高达 1 克被认为是安全的。对于他汀类药物优化后的二级预防，如果甘油三酯水平在 1.5 至 5.6 mmol/L 之间，指南建议在 1A 级证据的基础上，每天服用 2 克依泽替米贝两次。对于糖尿病和高甘油三酯血症以及其他 CVD 危险因素患者的一级预防，也建议使用。随着鱼类资源的减少，为发展中国家保护渔业以及从微藻或基因改造植物中获取 O3FA 可能变得越来越重要。
所有指南都建议每周至少食用 2 份油性鱼，尽管 O3FAs 的益处主要见于二级预防。在适当服用他汀类药物的患者中，无论预防级别如何，任何剂量的鱼油和 EPA 和 DHA 的组合制剂都未能显示出益处。对于服用他汀类药物且甘油三酯水平较高的选定患者，高剂量 EPA 显示出显著益处。
