Charnock J S
Cardiac Research Unit, Glenthorne Laboratory, CSIRO, Australia.
Prog Lipid Res. 1994;33(4):355-85. doi: 10.1016/0163-7827(94)90023-x.
In any discussion of lipids and heart disease it is beneficial from the outset to recognise that at least three different pathological processes may be involved. The first of these is atherosclerosis which involves the deposition of "fat" in the coronary vessels, another is thrombogenesis which describes the formation of blood clots in the coronary vessels, and the third is arrhythmia which refers to disorders in the beating of the heart which may become sufficiently serious to cause sudden cardiac death (SCD). Also it is this disturbance in the rhythmic beating of the heart which is responsible for much of the mortality from 'heart attacks' which occur 'outside-of-hospital' in societies like U.S.A., U.K. and Australia. It is this latter condition of cardiac arrhythmia which is the major concern of this review. Because it is often difficult to differentiate the role of lipids in 'heart disease' in man, it has frequently been assumed that all dietary fatty acids have similar effects on the different processes involved, and many unwarranted generalisations have been made which have led to conflicts of opinion amongst physicians and confusion in the lay public. From the animal studies discussed in this review, it is apparent that dietary fatty acids have an important role to play in determining the vulnerability of the myocardium to develop serious ventricular fibrillation (VF) and potentially lethal cardiac arrhythmia. In general, diets rich in saturated fatty acids promote a state of myocardial vulnerability, whilst diets rich in PUFA significantly diminish the probability of developing lethal disorders in cardiac rhythm when the heart is placed under pharmacological (or emotional) stress, or deprived of sufficient blood flow and supply of oxygen. Very recent experiments with the monounsaturated fatty acid (MUFA) oleic acid clearly demonstrate that, at least in rats subjected to ligation of their coronary artery, this acid is not 'neutral' as has been suggested by some for its role in atherosclerosis, but in fact is indistinguishable from saturated fatty acids in its effect in promoting arrhythmia during either regional ischaemia or reperfusion arrhythmia in this animal model of SCD.(ABSTRACT TRUNCATED AT 400 WORDS)
在任何关于脂质与心脏病的讨论中，从一开始就认识到可能涉及至少三种不同的病理过程是有益的。其中第一个是动脉粥样硬化，它涉及“脂肪”在冠状动脉中的沉积；另一个是血栓形成，它描述了冠状动脉中血凝块的形成；第三个是心律失常，它指的是心脏跳动紊乱，这种紊乱可能严重到足以导致心源性猝死（SCD）。同样，正是这种心脏节律跳动的紊乱导致了在美国、英国和澳大利亚等社会中“院外”发生的“心脏病发作”造成的大量死亡。心律失常的后一种情况是本综述主要关注的问题。由于在人类中往往难以区分脂质在“心脏病”中的作用，人们常常认为所有膳食脂肪酸对所涉及的不同过程都有相似的影响，并且做出了许多毫无根据的概括，这导致了医生之间的意见冲突和普通民众的困惑。从本综述中讨论的动物研究可以明显看出，膳食脂肪酸在决定心肌发生严重室颤（VF）和潜在致命性心律失常的易感性方面起着重要作用。一般来说，富含饱和脂肪酸的饮食会促进心肌易损状态，而富含多不饱和脂肪酸（PUFA）的饮食在心脏受到药理学（或情绪）应激、或缺乏足够的血流和氧气供应时，会显著降低发生致命性心律紊乱的可能性。最近对单不饱和脂肪酸（MUFA）油酸的实验清楚地表明，至少在冠状动脉结扎的大鼠中，这种酸并不像一些人认为的那样在动脉粥样硬化中起“中性”作用，实际上在这种SCD动物模型中，无论是局部缺血还是再灌注心律失常期间，它在促进心律失常方面的作用与饱和脂肪酸没有区别。（摘要截断于400字）
