Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals.
Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals.
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DOI：
10.1001/jamacardio.2017.5205
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发表时间：
2018-03-01
期刊：
影响因子：
24
通讯作者：
Omega-3 Treatment Trialists’ Collaboration
中科院分区：
文献类型：
--
作者：
Aung T;Halsey J;Kromhout D;Gerstein HC;Marchioli R;Tavazzi L;Geleijnse JM;Rauch B;Ness A;Galan P;Chew EY;Bosch J;Collins R;Lewington S;Armitage J;Clarke R;Omega-3 Treatment Trialists’ Collaboration
补充海洋来源的omega-3脂肪酸是否与心血管疾病高危人群中致命或非致命冠心病的减少有关？这项涉及77917名参与者的10项试验的荟萃分析表明，平均4.4年补充海洋来源的omega-3脂肪酸与致命性或非致命性冠心病或任何主要血管事件的减少没有显着相关性。这些结果没有支持目前的建议，即使用omega-3脂肪酸补充剂预防患有心血管疾病或有患心血管疾病高风险的人的致命性冠心病或任何心血管疾病。这项对10项大型试验的荟萃分析评估了欧米茄-3脂肪酸补充剂与77，917名高风险个体发生致命和非致命冠心病和重大血管事件风险的相关性。目前的指南提倡使用海洋来源的omega-3脂肪酸补充剂来预防冠心病和既往冠心病患者的主要血管事件，但omega-3脂肪酸的大型试验产生了相互矛盾的结果。对所有大型试验进行荟萃分析，评估在整个研究人群和预先指定的亚组中，omega-3脂肪酸补充剂与致死性和非致死性冠心病和主要血管事件风险的相关性。这项荟萃分析包括随机试验，涉及至少500名参与者，治疗持续时间至少1年，并评估了omega-3脂肪酸与血管事件风险的相关性。汇总的研究水平数据来自10项大型随机临床试验。使用观察值减去预期统计量和方差合成每项试验的率比。通过固定效应荟萃分析，使用主要疾病的95%置信区间和所有亚组的99%置信区间估计汇总率比。主要结局包括致死性冠心病、非致死性心肌梗死、卒中、主要血管事件和全因死亡率，以及研究人群亚组中的主要血管事件。在参与10项试验的77917名高风险个体中，47803名（61.4%）为男性，入组时的平均年龄为64.0岁;试验平均持续4.4年。对6273例冠心病事件（2695例冠心病死亡和2276例非致死性心肌梗死）和12001例主要血管事件的治疗与结局的相关性进行了评估。随机接受omega-3脂肪酸补充剂（二十碳五烯酸剂量范围，226-1800 mg/d）与冠心病死亡无显著相关性（率比[RR]，0.93; 99% CI，0.83-1.03; P = 0.05），非致死性心肌梗死（RR，0.97; 99% CI，0.87-1.08; P = .43）或任何冠心病事件（RR，0.96; 95% CI，0.90-1.01; P = .12）。无论是总体还是任何亚组，包括既往患有冠心病、糖尿病、血脂水平高于给定临界水平或使用他汀类药物的患者组成的亚组，随机分配补充omega-3脂肪酸与主要血管事件均无任何显著相关性（RR，0.97; 95%CI，0.93-1.01; P = 0.10）。这项荟萃分析表明，omega-3脂肪酸与致命性或非致命性冠心病或任何主要血管事件没有显著相关性。它不支持目前对有冠心病史的人使用此类补充剂的建议。
Does supplementation with marine-derived omega-3 fatty acids have any associations with reductions in fatal or nonfatal coronary heart disease in people at high risk of cardiovascular disease? This meta-analysis of 10 trials involving 77 917 participants demonstrated that supplementation with marine-derived omega-3 fatty acids for a mean of 4.4 years had no significant association with reductions in fatal or nonfatal coronary heart disease or any major vascular events. The results provide no support for current recommendations to use omega-3 fatty acid supplements for the prevention of fatal coronary heart disease or any cardiovascular disease in people who have or at high risk of developing cardiovascular disease. This meta-analysis of 10 large trials assessed the associations of omega-3 fatty acid supplements with the risk of fatal and nonfatal coronary heart disease and major vascular events in 77 917 high-risk individuals. Current guidelines advocate the use of marine-derived omega-3 fatty acids supplements for the prevention of coronary heart disease and major vascular events in people with prior coronary heart disease, but large trials of omega-3 fatty acids have produced conflicting results. To conduct a meta-analysis of all large trials assessing the associations of omega-3 fatty acid supplements with the risk of fatal and nonfatal coronary heart disease and major vascular events in the full study population and prespecified subgroups. This meta-analysis included randomized trials that involved at least 500 participants and a treatment duration of at least 1 year and that assessed associations of omega-3 fatty acids with the risk of vascular events. Aggregated study-level data were obtained from 10 large randomized clinical trials. Rate ratios for each trial were synthesized using observed minus expected statistics and variances. Summary rate ratios were estimated by a fixed-effects meta-analysis using 95% confidence intervals for major diseases and 99% confidence intervals for all subgroups. The main outcomes included fatal coronary heart disease, nonfatal myocardial infarction, stroke, major vascular events, and all-cause mortality, as well as major vascular events in study population subgroups. Of the 77 917 high-risk individuals participating in the 10 trials, 47 803 (61.4%) were men, and the mean age at entry was 64.0 years; the trials lasted a mean of 4.4 years. The associations of treatment with outcomes were assessed on 6273 coronary heart disease events (2695 coronary heart disease deaths and 2276 nonfatal myocardial infarctions) and 12 001 major vascular events. Randomization to omega-3 fatty acid supplementation (eicosapentaenoic acid dose range, 226-1800 mg/d) had no significant associations with coronary heart disease death (rate ratio [RR], 0.93; 99% CI, 0.83-1.03; P = .05), nonfatal myocardial infarction (RR, 0.97; 99% CI, 0.87-1.08; P = .43) or any coronary heart disease events (RR, 0.96; 95% CI, 0.90-1.01; P = .12). Neither did randomization to omega-3 fatty acid supplementation have any significant associations with major vascular events (RR, 0.97; 95% CI, 0.93-1.01; P = .10), overall or in any subgroups, including subgroups composed of persons with prior coronary heart disease, diabetes, lipid levels greater than a given cutoff level, or statin use. This meta-analysis demonstrated that omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease or any major vascular events. It provides no support for current recommendations for the use of such supplements in people with a history of coronary heart disease.
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影响因子：
37.8
作者：
Rauch, Bernhard;Schiele, Rudolf;Senges, Jochen
通讯作者：
Senges, Jochen
影响因子：
39.3
作者：
Eussen, Simone R. B. M.;Geleijnse, Johanna M.;Kromhout, Daan
通讯作者：
Kromhout, Daan
影响因子：
158.5
作者：
KROMHOUT, D;BOSSCHIETER, EB;COULANDER, CD
通讯作者：
COULANDER, CD
影响因子：
2.2
作者：
Manson JE;Bassuk SS;Lee IM;Cook NR;Albert MA;Gordon D;Zaharris E;Macfadyen JG;Danielson E;Lin J;Zhang SM;Buring JE
通讯作者：
Buring JE
影响因子：
39.3
作者：
Piepoli, Massimo F.;Hoes, Arno W.;Verschuren, W. M. Monique
通讯作者：
Verschuren, W. M. Monique