Efficacy and Safety of Omega-3 Fatty Acids in the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis
Efficacy and Safety of Omega-3 Fatty Acids in the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis
复制标题
Omega-3 脂肪酸预防心血管疾病的功效和安全性：系统评价和荟萃分析
DOI：
10.1007/s10557-022-07379-z
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发表时间：
2022
影响因子：
3.4
通讯作者：
Zhang
中科院分区：
文献类型：
--
作者：
Zhang
人们普遍认为omega-3脂肪酸有益于预防心血管疾病，但许多大型随机对照试验研究和荟萃分析得出了不同的结论。补充omega-3脂肪酸预防心血管疾病的证据仍然不足。我们进行了一项系统的综述和荟萃分析，以评估几种类型的omega-3脂肪酸补充剂的有效性和安全性。我们全面搜索了在线数据库，找到了15个随机对照试验。主要疗效结果包括主要心血管事件、心肌梗死、心力衰竭、房颤、中风、心血管死亡和全因死亡。安全终点包括胃肠道问题、出血相关疾病和癌症。根据人群的主要特征进行亚组分析，通过Meta回归分析评价omega-3脂肪酸的剂量-反应关系。所有结果均采用随机效应模型计算。统计异质性使用卡方检验进行评估，并使用i平方统计进行量化。与对照组相比，omega-3脂肪酸组的主要心血管事件(RR0.95，95%CI0.91~0.99，P=0.026)、心肌梗死(RR0.90，95%CI0.83~0.98；P=0.021)和心血管死亡(RR0.94，95%CI0.88~0.99；P=0.028)的发生率明显降低。在omega-3脂肪酸组患者中观察到心房颤动的风险增加(RR1.25，95%CI1.10至1.41；P=0.000)。在心力衰竭、中风和全因死亡方面，两组之间没有统计学差异。在安全终点方面，两组在胃肠道问题、出血相关疾病和癌症方面没有统计学上的显著差异。亚组分析表明，omega-3脂肪酸对心血管的益处主要归因于EPA乙酯的处方。Omega-3脂肪酸可能会降低有心血管疾病或危险因素的患者发生重大心血管事件的风险，并降低无心血管疾病患者的心肌梗死风险；但它们可能会增加有心肌梗死患者的中风风险。此外，处方omega-3酸乙酯具有良好的安全性，处方EPA乙酯有很高的出血风险。适度的证据表明，使用omega-3脂肪酸可以降低重大心血管事件、心肌梗死和心血管死亡的风险。与其他类型的omega-3脂肪酸补充剂相比，我们支持使用处方EPA乙酯配方来预防心血管疾病，但心房颤动和出血的潜在风险不容忽视。值得注意的是，在既往有心肌梗死史的患者中，应谨慎使用omega-3脂肪酸，这可能会增加中风的风险。最后，omega-3脂肪酸相对安全，通常不会增加胃肠道问题、出血相关疾病或癌症，但需要注意处方EPA乙酯配方的出血风险。
It is widely accepted that omega-3 fatty acids are beneficial in the prevention of cardiovascular disease, but many large randomized controlled trial studies and meta-analyses have come to different conclusions. The evidence for omega-3 fatty acids supplementation to prevent cardiovascular disease remains insufficient. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of several types of omega-3 fatty acids supplements. We comprehensively searched the online database and found 15 RCTs. The primary efficacy outcomes included major cardiovascular events, myocardial infarction, heart failure, atrial fibrillation, stroke, cardiovascular death, and all-cause death. The safety endpoints included gastrointestinal problems, bleeding-related disorders, and cancer. Subgroup analysis was conducted according to the main characteristics of the population, and the dose-response relationship of omega-3 fatty acids was evaluated by meta-regression. All results were calculated by the random effect model. Statistical heterogeneity was assessed using chi-square tests and quantified using I-square statistics. The incidence of major cardiovascular events (RR 0.95, 95%CI 0.91 to 0.99, P = 0.026), myocardial infarction (RR 0.90, 95%CI 0.83 to 0.98; P = 0.021), and cardiovascular death (RR 0.94, 95%CI 0.88 to 0.99; P = 0.028) was reduced in the omega-3 fatty acid group compared with the control group. An increased risk of atrial fibrillation (RR 1.25, 95%CI 1.10 to 1.41; P = 0.000) was observed in patients in the omega-3 fatty acid group. No statistical differences were observed between the two groups in heart failure, stroke, and all-cause death. For safety endpoints, there were no statistically significant differences between the two groups in gastrointestinal problems, bleeding-related disorders, and cancer. Subgroup analysis showed that the cardiovascular benefit of omega-3 fatty acids was primarily attributable to the prescription of EPA ethyl ester. Omega-3 fatty acids may reduce the risk of major cardiovascular events in patients with cardiovascular disease or risk factors, and reduce the risk of myocardial infarction in patients without cardiovascular disease; however, they may increase the risk of stroke in patients with myocardial infarction. In addition, prescription omega-3 acid ethyl ester has a good safety profile, and prescription EPA ethyl ester has a high risk of bleeding. Moderate evidence showed that the use of omega-3 fatty acids may reduce the risk of major cardiovascular events, myocardial infarction, and cardiovascular death. Compared to other types of omega-3 fatty acids supplements, we support the use of prescription EPA ethyl ester formulations for the prevention of cardiovascular disease, but the potential risk of atrial fibrillation and bleeding cannot be ignored. It is important to note that omega-3 fatty acids should be applied with caution in patients with previous myocardial infarction, which may increase the risk of stroke. Finally, omega-3 fatty acids are relatively safe and in general do not increase gastrointestinal problems, bleeding-related disorders, or cancer, but attention needs to be paid to the risk of bleeding with prescription EPA ethyl ester formulations.
影响因子：
1.5
作者：
C. von Schacky
通讯作者：
C. von Schacky
DOI：
10.1016/j.trsl.2015.06.017
发表时间：
2016-01
期刊：
Translational research : the journal of laboratory and clinical medicine
影响因子：
--
作者：
Welty FK;Alfaddagh A;Elajami TK
通讯作者：
Elajami TK
影响因子：
6.1
作者：
N. Sheard
通讯作者：
N. Sheard