Effects of n-3 fatty acids on major cardiovascular events in statin users and non-users with a history of myocardial infarction
Effects of n-3 fatty acids on major cardiovascular events in statin users and non-users with a history of myocardial infarction
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DOI：
10.1093/eurheartj/ehr499
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发表时间：
2012-07-01
影响因子：
39.3
通讯作者：
Kromhout, Daan
中科院分区：
文献类型：
--
作者：
Eussen, Simone R. B. M.;Geleijnse, Johanna M.;Kromhout, Daan
最近的二级预防试验未能证明n-3脂肪酸对心血管结果的有益影响，这可能是由于自20世纪90年代中期以来他汀类药物的使用越来越多。本研究的目的是评估他汀类药物是否能改变有心肌梗死病史的患者中n-3脂肪酸对主要心血管不良事件的影响。参与Alpha Omega试验的患者被分为使用他汀类药物的患者(3740例)和不使用他汀类药物的患者(413例)。在这两组患者中，评估了每天额外服用400毫克二十碳五烯酸(EPA)和/或二十二碳六烯酸(DHA)和/或2g-亚麻酸(ALA)对主要心血管事件的影响。多变量COXS比例风险模型用于计算调整后的风险比(HRADJ)。在他汀类药物使用者中，495(13)人和在非他汀类药物使用者中，62(15)人发生了重大心血管事件。在他汀类药物使用者中，额外的n-3脂肪酸并没有减少心血管事件[HRADJ 1.02；95可信区间(CI)：0.80，1.31；P 0.88]。然而，在没有服用他汀类药物的患者中，接受EPADHA和ALA治疗的患者中只有9人发生了事件，而安慰剂组有18人发生了事件(HRADJ0.46；95CI：0.21，1.01；P 0.051)。在有心肌梗死病史的患者中，没有接受他汀类药物治疗的患者，补充低剂量的n-3脂肪酸可能会减少主要的心血管事件。这项研究表明，他汀类药物治疗可以改变n-3脂肪酸对主要心血管事件发生率的影响。
Recent secondary prevention trials have failed to demonstrate a beneficial effect of n-3 fatty acids on cardiovascular outcomes, which may be due to the growing use of statins since the mid-1990s. The aim of the present study was to assess whether statins modify the effects of n-3 fatty acids on major adverse cardiovascular events in patients with a history of myocardial infarction (MI).Patients who participated in the Alpha Omega Trial were divided into consistent statin users (n 3740) and consistent statin non-users (n 413). In these two groups of patients, the effects of an additional daily amount of 400 mg eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA), 2 g -linolenic acid (ALA), or both on major cardiovascular events were evaluated. Multivariable Coxs proportional hazard models were used to calculate adjusted hazard rate ratios (HRadj). Among the statin users 495 (13) and among the statin non-users 62 (15) developed a major cardiovascular event. In statin users, an additional amount of n-3 fatty acids did not reduce cardiovascular events [HRadj 1.02; 95 confidence interval (CI): 0.80, 1.31; P 0.88]. In statin non-users, however, only 9 of those who received EPADHA plus ALA experienced an event compared with 18 in the placebo group (HRadj 0.46; 95 CI: 0.21, 1.01; P 0.051).In patients with a history of MI who are not treated with statins, low-dose supplementation with n-3 fatty acids may reduce major cardiovascular events. This study suggests that statin treatment modifies the effects of n-3 fatty acids on the incidence of major cardiovascular events.ClinicalTrials.gov number: NCT00127452.