Micronutrient Supplementation to Reduce Cardiovascular Risk
Micronutrient Supplementation to Reduce Cardiovascular Risk
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DOI：
10.1016/j.jacc.2022.09.048
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发表时间：
2022-12-05
影响因子：
24
通讯作者：
Liu, Simin
中科院分区：
文献类型：
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作者：
An, Peng;Wan, Sitong;Liu, Simin
背景 健康的饮食模式富含微量营养素，但它们对心血管疾病 (CVD) 风险的影响尚未得到系统量化。 目的 本研究的目标是提供全面且最新的循证图谱，系统量化微量营养素对 CVD 结果的影响。 方法 本研究对微量营养素对 CVD 危险因素和临床事件的随机对照干预试验进行系统回顾和荟萃分析。 结果 共有 884 项随机对照试验确定了在 883,627 名参与者（4,895,544 人年）中评估 27 种微量营养素的干预试验。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、褪黑激素、儿茶素、姜黄素、黄烷醇、染料木黄酮和槲皮素显示出中等到高质量的证据可以减少 CVD 危险因素。具体来说，补充 n-3 脂肪酸可降低 CVD 死亡率（相对风险 [RR]：0.93；95% CI：0.88-0.97）、心肌梗死（RR：0.85；95% CI：0.78-0.92）和冠心病事件（RR：0.86；95% CI：0.80-0.93）。补充叶酸可降低中风风险（RR：0.84；95% CI：0.72-0.97），补充辅酶 Q10 可减少全因死亡事件（RR：0.68；95% CI：0.49-0.94）。维生素 C、维生素 D、维生素 E 和硒对 CVD 或 2 型糖尿病风险没有影响。补充 β-胡萝卜素会增加全因死亡率（RR：1.10；95% CI：1.05-1.15）、CVD 死亡事件（RR：1.12；95% CI：1.06-1.18）和中风风险（RR：1.09；95% CI：1.01-1.17）。 结论 补充部分但不是全部微量营养素可能有益于心脏代谢健康。这项研究强调了微量营养素多样性以及利益与风险平衡对于促进和维持不同人群心血管健康的重要性。 （补充抗氧化剂预防和治疗心血管疾病；CRD42022315165）(c) 2022 年，美国心脏病学会基金会。
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, alpha-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. beta-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) (c) 2022 by the American College of Cardiology Foundation.