O'Keefe Evan L, O'Keefe James H, Abuissa Hussam, Metzinger Mark, Murray Ellen, Franco Grant, Lavie Carl J, Harris William S
Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States of America.
Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States of America.
Prog Cardiovasc Dis. 2024 Nov 30. doi: 10.1016/j.pcad.2024.11.003.
Studies regarding effects of omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on risk of atrial fibrillation (AF) have reported discordant results. The aim of this review is to clarify effects of marine omega-3 intake on risk of AF.
A PubMed search was performed using terms: atrial fibrillation, omega-3, EPA, DHA, vagal tone. We summarized findings from randomized clinical trials (RCTs), epidemiology studies, and meta-analyses evaluating effects/associations of DHA + EPA on risk of AF. Also, vagal tone was explored as a mediator between omega-3 and risk of AF.
Meta-analyses of 8 RCTs and 17 prospective cohort studies comprised of 83,112 and 54,799 individuals, respectively, investigated the link between omega-3 intake and incident AF. The RCTs reported that treatment with DHA and/or EPA was associated with a 24 % increased relative risk of AF (absolute risk 4.0 % vs 3.3 %; relative risk [RR] 1.24, 95 % confidence interval [CI] 1.11-1.38, p = 0.0002). This was dose-dependent; DHA + EPA doses of ∼1000 mg/d increased AF risk ∼12 %, whereas 1800 to 4000 mg/d increased AF risk by ∼50 %. In contrast, observational studies focused on DHA + EPA blood levels or dietary intake have generally reported that higher omega-3 levels/consumption are associated with lower AF risk. Maximal AF risk reduction. (12 %) occurred at ∼650 mg/d of dietary DHA + EPA. Other studies have indicated that omega-3 fatty acids can dose-dependently increase vagal tone, which could explain the biphasic relationship between DHA + EPA and AF risk. Experimental studies show that low-level vagal stimulation decreases risk of AF, whereas high-level vagal stimulation increases risk of AF.
Higher consumption of dietary omega-3 is associated with decreased AF risk. In contrast, pharmaceutical dosing of omega-3 increases AF in a dose-dependent manner, which may be mediated by vagal tone.
关于ω-3脂肪酸，特别是二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）对心房颤动（AF）风险影响的研究报告结果不一致。本综述的目的是阐明摄入海洋ω-3脂肪酸对AF风险的影响。
在PubMed上进行检索，检索词为：心房颤动、ω-3、EPA、DHA、迷走神经张力。我们总结了评估DHA+EPA对AF风险影响/关联的随机临床试验（RCT）、流行病学研究和荟萃分析的结果。此外，还探讨了迷走神经张力作为ω-3与AF风险之间的中介因素。
对分别包含83112例和54799例个体的8项RCT和17项前瞻性队列研究进行荟萃分析，以研究ω-3脂肪酸摄入与新发AF之间的联系。RCT报告称，DHA和/或EPA治疗使AF的相对风险增加24%（绝对风险4.0%对3.3%；相对风险[RR]1.24，95%置信区间[CI]1.11 - 1.38，p = 0.0002）。这呈剂量依赖性；DHA + EPA剂量约为1000mg/d时，AF风险增加约12%，而1800至4000mg/d时，AF风险增加约50%。相比之下，关注DHA + EPA血液水平或饮食摄入量的观察性研究普遍报告称，较高的ω-3水平/摄入量与较低的AF风险相关。膳食中DHA + EPA摄入量约为650mg/d时，AF风险降低最大（12%）。其他研究表明，ω-3脂肪酸可剂量依赖性地增加迷走神经张力，这可以解释DHA + EPA与AF风险之间的双相关系。实验研究表明，低水平迷走神经刺激可降低AF风险，而高水平迷走神经刺激则增加AF风险。
较高的膳食ω-3脂肪酸摄入量与降低AF风险相关。相比之下，ω-3脂肪酸的药物剂量以剂量依赖性方式增加AF风险，这可能由迷走神经张力介导。
