Omega-3 fatty acids: antiarrhythmic, proarrhythmic or both?
Omega-3 fatty acids: antiarrhythmic, proarrhythmic or both?
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DOI：
10.1097/mco.0b013e3282f44bdf
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发表时间：
2008-03-01
影响因子：
3.1
通讯作者：
von Schacky, Clemens
中科院分区：
文献类型：
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作者：
von Schacky, Clemens
综述目的最近的出版物似乎表明海洋 omega-3 脂肪酸二十碳五烯酸和二十二碳六烯酸对心律没有影响或产生不良影响。这篇综述对这些进展进行了展望。最近的研究结果在体外或动物模型中，几乎没有促心律失常作用，但 omega-3 脂肪酸有许多抗心律失常机制已被记录。在人类干预研究中，二十碳五烯酸加二十二碳六烯酸可抑制接受冠状动脉搭桥术的患者新发的心房颤动。更重要的是，系统评价已证明二十碳五烯酸加二十二碳六烯酸可使心源性猝死减少 50%。最近发表的一项针对日本心血管高危患者的二十碳五烯酸干预研究中，心源性猝死的情况很少见。心源性猝死在日本普通人群中更为罕见：其发生频率比欧洲普通人群低 20 倍。德国。在日本，二十碳五烯酸和二十二碳六烯酸的含量较高（omega-3 指数估计约为 11%），而在德国，二十碳五烯酸和二十二碳六烯酸的含量较低（omega-3 指数约为 4%）。这些数据和其他数据强化了这样的概念，即低 omega-3 指数是心源性猝死的危险因素，作为评估人的二十碳五烯酸加二十二碳六烯酸状态的工具，以及作为监测二十碳五烯酸加二十二碳六烯酸治疗的手段。摘要对二十碳五烯酸加二十二碳六烯酸的促心律失常作用的担忧很大程度上是理论上的。支持抗心律失常作用的证据是压倒性的，特别是考虑到 omega-3 指数时。
Purpose of reviewRecent publications seem to indicate no or an untoward effect of the marine omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid on cardiac rhythm. This review puts these developments into perspective.Recent findingsIn-vitro or in animal models, little pro-arrhythmic effect, but many antiarrhythmic mechanisms of omega-3 fatty acids have been documented. In intervention studies in humans, eicosapentaenoic acid plus docosahexaenoic acid suppressed new atrial fibrillation in patients undergoing coronary bypass grafting. More importantly, in systematic reviews, it has been demonstrated that eicosapentaenoic acid plus docosahexaenoic acid reduce sudden cardiac death by 50%. In a recently published intervention study with eicosapentaenoic acid in patients at high cardiovascular risk in Japan, sudden cardiac death was rare. Sudden cardiac death is even rarer in the general population of Japan: it occurs 20 times less frequently than in the general population in Europe, e.g. Germany. In Japan, levels of eicosapentaenoic acid plus docosahexaenoic acid are high (omega-3 index estimated around 11%), whereas in Germany levels of eicosapentaenoic acid plus docosahexaenoic acid acids are low (omega-3 index around 4%). These and other data strengthen the concept that a low omega-3 index is a risk factor for sudden cardiac death, as a tool to assess the status of a person in terms of eicosapentaenoic acid plus docosahexaenoic acid, and as a means to monitor therapy with eicosapentaenoic acid plus docosahexaenoic acid.SummaryConcerns about pro-arrhythmic effects of eicosapentaenoic acid plus docosahexaenoic acid are largely theoretical. The evidence in favour of an antiarrhythmic effect is overwhelming, especially, when factoring in the omega-3 index.