Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy.
Eur J Prev Cardiol. 2024 Nov 11;31(15):1863-1875. doi: 10.1093/eurjpc/zwae184.
Benefits of pharmacologic omega-3 fatty acid administration in cardiovascular prevention are controversial. Particularly, effects on coronary revascularization are unclear; also debated are specific benefits of eicosapentaenoic acid (EPA). We investigated incident coronary revascularizations, myocardial infarction (MI), stroke, heart failure (HF), unstable angina, and cardiovascular death, in subjects randomized to receive EPA or EPA + docosahexaenoic acid (EPA + DHA) vs. control.
Meta-analysis of randomized controlled trials (RCTs) was conducted after MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library search. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed for abstracting data and assessing data quality and validity. Data were pooled using a random effects model. Eighteen RCTs with 134 144 participants (primary and secondary cardiovascular prevention) receiving DHA + EPA (n = 52 498), EPA alone (n = 14 640), or control/placebo (n = 67 006) were included. Follow-up ranged from 4.5 months to 7.4 years. Overall, compared with controls, omega-3 supplementation reduced the risk of revascularization [0.90, 95% confidence interval (CI) 0.84-0.98; P = 0.001; P-heterogeneity = 0.0002; I2 = 68%], MI (0.89, 95% CI 0.81-0.98; P = 0.02; P-heterogeneity = 0.06; I2 = 41%), and cardiovascular death (0.92, 95% CI 0.85-0.99; P = 0.02; P-heterogeneity = 0.13; I2 = 33%). Lower risk was still observed in trials where most participants (≥60%) were on statin therapy. Compared with DHA + EPA, EPA alone showed a further significant risk reduction of revascularizations (0.76, 95% CI 0.65-0.88; P = 0.0002; P-interaction = 0.005) and all outcomes except HF.
Omega-3 fatty acid supplementation reduced the risk of cardiovascular events and coronary revascularization, regardless of background statin use. Eicosapentaenoic acid alone produced greater benefits. The role of specific omega-3 molecules in primary vs. secondary prevention and the potential benefits of reduced revascularizations on overall health status and cost savings warrant further research.
ω-3 脂肪酸在心血管预防中的药理作用存在争议。特别是其对冠状动脉血运重建的影响尚不清楚；二十碳五烯酸（EPA）的具体益处也存在争议。我们研究了接受 EPA 或 EPA+二十二碳六烯酸（EPA+DHA）治疗的受试者与对照组相比，新发冠状动脉血运重建、心肌梗死（MI）、卒中和心力衰竭（HF）、不稳定型心绞痛和心血管死亡的发生率。
对 MEDLINE、Embase、Scopus、Web of Science 和 Cochrane Library 进行文献检索后，进行了随机对照试验（RCT）的荟萃分析。根据系统评价和荟萃分析的首选报告项目，对数据进行了提取，并评估了数据质量和有效性。使用随机效应模型对数据进行了汇总。纳入了 18 项 RCT，共 134144 名受试者（一级和二级心血管预防）接受 DHA+EPA（n=52498）、EPA 单药（n=14640）或安慰剂/对照（n=67006）治疗。随访时间从 4.5 个月到 7.4 年不等。总体而言，与对照组相比，ω-3 补充剂降低了血运重建的风险[0.90，95%置信区间（CI）0.84-0.98；P=0.001；P 异质性=0.0002；I2=68%]、心肌梗死[0.89，95%CI 0.81-0.98；P=0.02；P 异质性=0.06；I2=41%]和心血管死亡[0.92，95%CI 0.85-0.99；P=0.02；P 异质性=0.13；I2=33%]。在他汀类药物治疗比例较高（≥60%）的试验中，仍观察到较低的风险。与 DHA+EPA 相比，EPA 单药治疗进一步显著降低了血运重建的风险[0.76，95%CI 0.65-0.88；P=0.0002；P 交互作用=0.005]和除 HF 以外的所有结局。
ω-3 脂肪酸补充剂降低了心血管事件和冠状动脉血运重建的风险，无论是否使用他汀类药物作为背景治疗。单独使用二十碳五烯酸可带来更大的益处。特定 ω-3 分子在一级预防和二级预防中的作用，以及减少血运重建对整体健康状况和成本节约的潜在益处，需要进一步研究。
