John P. Sheppard MD, MS , Leonard Palatnic DO , Suvasini Lakshmanan MD, MS , Thomas Drago MD , Jaspreet Bhogal MD , Sion K. Roy MD , Deepak L. Bhatt MD, MPH, MBA , Matthew J. Budoff MD , John R. Nelson MD
{"title":"二十碳五烯酸与二十碳五烯酸/二十二碳六烯酸对心血管死亡率的影响","authors":"John P. Sheppard MD, MS , Leonard Palatnic DO , Suvasini Lakshmanan MD, MS , Thomas Drago MD , Jaspreet Bhogal MD , Sion K. Roy MD , Deepak L. Bhatt MD, MPH, MBA , Matthew J. Budoff MD , John R. Nelson MD","doi":"10.1016/j.jacadv.2025.102149","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Purified eicosapentaenoic acid (EPA) and mixed eicosapentaenoic/docosahexaenoic acids (EPA/DHA) are omega-3 polyunsaturated fatty acids (n-3 PUFAs) of interest for preventing cardiovascular disease (CVD) as adjunct to statins. Randomized clinical trial (RCT) evidence continues to emerge, including data from the RESPECT-EPA (Randomized Trial for Evaluation in Secondary Prevention Efficacy of Combination Therapy–Statin and Eicosapentaenoic Acid) trial, but n-3 PUFAs’ roles in prevention remains controversial.</div></div><div><h3>Objectives</h3><div>The objective of the study was to assess the efficacy of EPA vs EPA/DHA compared to the standard preventive therapy across published RCTs investigating the use of n-3 PUFAs for primary or secondary prevention of CVD.</div></div><div><h3>Methods</h3><div>Following a prespecified protocol registered in the PROSPERO database (<span><span>CRD42023390587</span><svg><path></path></svg></span>), we identified RCTs reporting CVD-attributable mortality in patients randomized to EPA, EPA/DHA, or a standard preventive therapy for primary or secondary CVD prevention. We used random effects meta-analysis to estimate pooled HRs of CVD-attributable mortality achieved with EPA or EPA/DHA relative to the standard preventive therapy.</div></div><div><h3>Results</h3><div>Sixteen RCTs met the inclusion criteria, representing 127,771 patients in total (41% women, mean age 64 ± 5 years). Median follow-up was 3.7 years (IQR: 2.7-5.0 years). Compared to the standard preventive therapy, CVD-attributable mortality was significantly reduced with purified EPA (HR: 0.79 [95% CI: 0.67-0.94]; <em>P</em> = 0.006); this effect was less for EPA/DHA (HR: 0.92 [95% CI: 0.84-1.00]; <em>P</em> = 0.044).</div></div><div><h3>Conclusions</h3><div>EPA lowered incident CVD-attributable mortality in RCTs investigating its use for primary or secondary CVD prevention. Relative to EPA, benefits reported with EPA/DHA were attenuated. Although more work is needed to understand these differences, EPA should preferentially be used in cardiovascular conditions for which it is indicated.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102149"},"PeriodicalIF":0.0000,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of Eicosapentaenoic Acid vs Eicosapentaenoic/Docosahexaenoic Acids on Cardiovascular Mortality\",\"authors\":\"John P. Sheppard MD, MS , Leonard Palatnic DO , Suvasini Lakshmanan MD, MS , Thomas Drago MD , Jaspreet Bhogal MD , Sion K. Roy MD , Deepak L. Bhatt MD, MPH, MBA , Matthew J. Budoff MD , John R. Nelson MD\",\"doi\":\"10.1016/j.jacadv.2025.102149\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Purified eicosapentaenoic acid (EPA) and mixed eicosapentaenoic/docosahexaenoic acids (EPA/DHA) are omega-3 polyunsaturated fatty acids (n-3 PUFAs) of interest for preventing cardiovascular disease (CVD) as adjunct to statins. Randomized clinical trial (RCT) evidence continues to emerge, including data from the RESPECT-EPA (Randomized Trial for Evaluation in Secondary Prevention Efficacy of Combination Therapy–Statin and Eicosapentaenoic Acid) trial, but n-3 PUFAs’ roles in prevention remains controversial.</div></div><div><h3>Objectives</h3><div>The objective of the study was to assess the efficacy of EPA vs EPA/DHA compared to the standard preventive therapy across published RCTs investigating the use of n-3 PUFAs for primary or secondary prevention of CVD.</div></div><div><h3>Methods</h3><div>Following a prespecified protocol registered in the PROSPERO database (<span><span>CRD42023390587</span><svg><path></path></svg></span>), we identified RCTs reporting CVD-attributable mortality in patients randomized to EPA, EPA/DHA, or a standard preventive therapy for primary or secondary CVD prevention. We used random effects meta-analysis to estimate pooled HRs of CVD-attributable mortality achieved with EPA or EPA/DHA relative to the standard preventive therapy.</div></div><div><h3>Results</h3><div>Sixteen RCTs met the inclusion criteria, representing 127,771 patients in total (41% women, mean age 64 ± 5 years). Median follow-up was 3.7 years (IQR: 2.7-5.0 years). Compared to the standard preventive therapy, CVD-attributable mortality was significantly reduced with purified EPA (HR: 0.79 [95% CI: 0.67-0.94]; <em>P</em> = 0.006); this effect was less for EPA/DHA (HR: 0.92 [95% CI: 0.84-1.00]; <em>P</em> = 0.044).</div></div><div><h3>Conclusions</h3><div>EPA lowered incident CVD-attributable mortality in RCTs investigating its use for primary or secondary CVD prevention. Relative to EPA, benefits reported with EPA/DHA were attenuated. Although more work is needed to understand these differences, EPA should preferentially be used in cardiovascular conditions for which it is indicated.</div></div>\",\"PeriodicalId\":73527,\"journal\":{\"name\":\"JACC advances\",\"volume\":\"4 10\",\"pages\":\"Article 102149\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC advances\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772963X25005745\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC advances","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772963X25005745","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
纯化二十碳五烯酸（EPA）和混合二十碳六烯酸/二十二碳六烯酸（EPA/DHA）是omega-3多不饱和脂肪酸（n-3 PUFAs），作为他汀类药物的辅助药物，可用于预防心血管疾病（CVD）。随机临床试验（RCT）证据不断出现，包括来自RESPECT-EPA（评价他汀类药物和二十碳五烯酸联合治疗的二级预防疗效的随机试验）试验的数据，但n-3 PUFAs在预防中的作用仍然存在争议。本研究的目的是评估EPA与EPA/DHA相比标准预防治疗的有效性，这些已发表的随机对照试验调查了n-3 PUFAs用于心血管疾病一级或二级预防的情况。方法：根据在PROSPERO数据库（CRD42023390587）中注册的预先指定的方案，我们确定了随机分配到EPA、EPA/DHA或标准预防治疗的原发性或继发性CVD预防的患者中报告CVD归因于死亡率的rct。我们使用随机效应荟萃分析来估计EPA或EPA/DHA相对于标准预防治疗所达到的cvd归因死亡率的总hr。结果16项rct符合纳入标准，共纳入127771例患者（女性41%，平均年龄64±5岁）。中位随访3.7年（IQR: 2.7-5.0年）。与标准预防治疗相比，纯化EPA可显著降低cvd归因死亡率（HR: 0.79 [95% CI: 0.67-0.94]; P = 0.006）；EPA/DHA的影响较小（HR: 0.92 [95% CI: 0.84-1.00]; P = 0.044）。结论：在调查sepa用于一级或二级CVD预防的随机对照试验中，sepa降低了CVD可归因死亡率。与EPA相比，EPA/DHA的益处有所减弱。尽管需要更多的工作来了解这些差异，EPA应该优先用于心血管疾病。
Effects of Eicosapentaenoic Acid vs Eicosapentaenoic/Docosahexaenoic Acids on Cardiovascular Mortality
Background
Purified eicosapentaenoic acid (EPA) and mixed eicosapentaenoic/docosahexaenoic acids (EPA/DHA) are omega-3 polyunsaturated fatty acids (n-3 PUFAs) of interest for preventing cardiovascular disease (CVD) as adjunct to statins. Randomized clinical trial (RCT) evidence continues to emerge, including data from the RESPECT-EPA (Randomized Trial for Evaluation in Secondary Prevention Efficacy of Combination Therapy–Statin and Eicosapentaenoic Acid) trial, but n-3 PUFAs’ roles in prevention remains controversial.
Objectives
The objective of the study was to assess the efficacy of EPA vs EPA/DHA compared to the standard preventive therapy across published RCTs investigating the use of n-3 PUFAs for primary or secondary prevention of CVD.
Methods
Following a prespecified protocol registered in the PROSPERO database (CRD42023390587), we identified RCTs reporting CVD-attributable mortality in patients randomized to EPA, EPA/DHA, or a standard preventive therapy for primary or secondary CVD prevention. We used random effects meta-analysis to estimate pooled HRs of CVD-attributable mortality achieved with EPA or EPA/DHA relative to the standard preventive therapy.
Results
Sixteen RCTs met the inclusion criteria, representing 127,771 patients in total (41% women, mean age 64 ± 5 years). Median follow-up was 3.7 years (IQR: 2.7-5.0 years). Compared to the standard preventive therapy, CVD-attributable mortality was significantly reduced with purified EPA (HR: 0.79 [95% CI: 0.67-0.94]; P = 0.006); this effect was less for EPA/DHA (HR: 0.92 [95% CI: 0.84-1.00]; P = 0.044).
Conclusions
EPA lowered incident CVD-attributable mortality in RCTs investigating its use for primary or secondary CVD prevention. Relative to EPA, benefits reported with EPA/DHA were attenuated. Although more work is needed to understand these differences, EPA should preferentially be used in cardiovascular conditions for which it is indicated.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
