ω-3鱼油脂肪酸有助心肌梗死发作后的康复

　　2016年8月2日，美国心脏学会官方期刊《循环》正式发表哈佛大学医学院布莱根妇女医院、南达科他大学桑福德医学院、麻省总医院（马萨诸塞州综合医院）、贝斯以色列女执事医疗中心、弗吉尼亚州健康诊断实验室、南达科他州Ω定量分析的OMEGA-REMODEL随机临床研究报告，发现给予心脏病发作患者每天一次高剂量ω-3鱼油脂肪酸半年，可改善心脏功能、减少未梗死心肌纤维化形成。

　　该研究为多中心、双盲、安慰剂对照试验，每天服用ω-3脂肪酸4g连续6个月的180例患者与服用安慰剂的178例患者相比，左室收缩末期容积指数（心脏病发作后患者结局预测指标）减少5.8%（P=0.017），非受损心肌结缔组织（纤维化）形成减少5.6%（P=0.026）。而且可见炎症生物标志物水平降低，表明ω-3鱼油脂肪酸具有抗炎作用。

　　因此，ω-3鱼油脂肪酸可使心脏更好收缩，同时减少未梗死区域纤维化。

Circulation. 2016 Aug 2;134(5):378-91.

Effect of Omega-3 Acid Ethyl Esters on Left Ventricular Remodeling After Acute Myocardial Infarction: The OMEGA-REMODEL Randomized Clinical Trial.

Heydari B, Abdullah S, Pottala JV, Shah R, Abbasi S, Mandry D, Francis SA, Lumish H, Ghoshhajra BB, Hoffmann U, Appelbaum E, Feng JH, Blankstein R, Steigner M, McConnell JP, Harris W, Antman EM, Jerosch-Herold M, Kwong RY.

Brigham and Women's Hospital, Boston, MA; Sanford School of Medicine, University of South Dakota, Sioux Fall; Massachusetts General Hospital, Boston; Beth Israel Deaconess Medical Center, Boston, MA; Health Diagnostic Laboratory, Inc., Richmond, VA; OmegaQuant Analytics, LLC, Sioux Falls, SD.

BACKGROUND: Omega-3 fatty acids from fish oil have been associated with beneficial cardiovascular effects, but their role in modifying cardiac structures and tissue characteristics in patients who have had an acute myocardial infarction while receiving current guideline-based therapy remains unknown.

METHODS: In a multicenter, double-blind, placebo-controlled trial, participants presenting with an acute myocardial infarction were randomly assigned 1:1 to 6 months of high-dose omega-3 fatty acids (n=180) or placebo (n=178). Cardiac magnetic resonance imaging was used to assess cardiac structure and tissue characteristics at baseline and after study therapy. The primary study endpoint was change in left ventricular systolic volume index. Secondary endpoints included change in noninfarct myocardial fibrosis, left ventricular ejection fraction, and infarct size.

RESULTS: By intention-to-treat analysis, patients randomly assigned to omega-3 fatty acids experienced a significant reduction of left ventricular systolic volume index (-5.8%, P=0.017), and noninfarct myocardial fibrosis (-5.6%, P=0.026) in comparison with placebo. Per-protocol analysis revealed that those patients who achieved the highest quartile increase in red blood cell omega-3 index experienced a 13% reduction in left ventricular systolic volume index in comparison with the lowest quartile. In addition, patients in the omega-3 fatty acid arm underwent significant reductions in serum biomarkers of systemic and vascular inflammation and myocardial fibrosis. There were no adverse events associated with high-dose omega-3 fatty acid therapy.

CONCLUSIONS: Treatment of patients with acute myocardial infarction with high-dose omega-3 fatty acids was associated with reduction of adverse left ventricular remodeling, noninfarct myocardial fibrosis, and serum biomarkers of systemic inflammation beyond current guideline-based standard of care.

CLINICAL TRIAL REGISTRATION: NCT00729430.