Эссенциальные жирные кислоты семейства омега-3 определяют жизненно важные процессы в организме. В многочисленных исследованиях продемонстрировано, что восполнение дефицита этих нутриентов, обусловленного особенностями современного питания, увеличением в пищевом рационе рыбы, ведет к уменьшению сердечно-сосудистой заболеваемости. Включение в терапию омега-3-полиненасыщенных жирных кислот в капсулах значительно снижает риск внезапной смерти у больных после инфаркта миокарда, увеличивает выживаемость при сердечной недостаточности, оказывает антиаритмический эффект. Цель настоящего обзора – еще раз привлечь внимание врачей к этому важному разделу медицины, напомнить о целесообразности использования омега-3-жирных кислот в качестве эффективных средств первичной и вторичной профилактики сердечно-сосудистой патологии, необходимости более широкого их применения у больных с инфарктом миокарда, при сердечной недостаточности, включении в комплексное лечение аритмии.
Omega-3 essential fatty acids have major roles in all sorts of bodily processes. Numerous observational studies demonstrate that increase consumption of fishmeal as a replacement of the nutrient deficiency caused by modern dietary habits tends to reduce risk of cardiovascular diseases. Taking omega 3 fatty acids capsules during therapy may significantly reduce sudden cardiac death in patients with a history of myocardial infarction; improve survival in congestive heart failure patients; possess antiarrhythmic effect. The main purpose of this review is to draw attention of doctors to this important therapeutic area and to remind that the use of omega-3 fatty acids is appropriate and effective for primary and secondary prevention of cardiovascular diseases, as well as to emphasize the necessity of its wide-ranging use in patients with myocardial infarction, heart failure, and adding in the combination therapy of arrhythmia.
1. Albert CM, Campos H, Stampler MJ et al. Blood PUFAs and the risk of sudden death. N Engl J Med 2002; 346: 1113–8.
2. Mozaffarian D, Lemaitre RN, Kuller LH et al. Cardiac Benefits of Fish Consumption May Depend onthe Type of Fish Meal Consumed. Circulation 2003; 107: 1372–7.
3. Chrysohoou C, Panagiotakos DB, Pitsavos C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. J Am Coll Cardiol 2004; 44: 152–8.
4. Iso H, Rexrode KM, Stampfer MJ. Intake of fish and omega-3 fatty acids and risk of stroke in women. J Am Med Assoc 2000; 285: 304–12.
5. Shekele RB, Missell LV, Paul O et al. Fish consumption and mortality from coronary heart disease. N Engl J Med 1985; 313: 820.
6. Hu FB, Bronner L, Willett WC et al. Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 2002; 287: 1815–21.
7. Daviglus ML Stamler J, Orencia AJ et al. Fish consumption and the 30 year risk of fatal myocardial infarction. N Engl J Med 1997; 336: 1046–53.
8. Kromhout D, Bosschieter EB, Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med 1990; 7: 173–6.
9. Kris-Etherton PM. Fish consumption, fish oil, omega-3 fatty acids and cardiovasculardisease. Circulation 2002; 106: 2747–57.
10. Siscovick DS, Raghunathan TE et al. Dietary intake and cell membrane levels of long chain o3 – polyunsaturated fatty acids and the risk of primary cardiac arrest. J Am Med Assoc 1995; 274: 1363–7.
11. Keli SO et al. Fish consumption and risk of stroke: the Zutphen Study. Stroke 1994; 25: 328–32.
12. Caro J, Klittich W, McGuire A. The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin. BMJ 1997; 315: 1577–82.
13. Myerburg RJ, Spooner PM. Opportunities for sudden death prevention: Directions for new clinical and basic research. Cardiovasc Res 2001; 50: 177–85.
14. Priori G, Aliot E, Blomstrom-Lundqvist C et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J 2001; 22: 1374–450.
15. Burr ML, Fehily AM, Gilbert JF et al. Effects ofchanges in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 1989; 2 (8666): 757–61.
16. Erkkila AT, Mattman NR, Herrington DM, Lichtenstein AH. Higher plasma docosahexaenoic acid is associated with reduced progression of coronary atherosclerosis in women with CAD. J Lipid Res 2006; 47: 2814–9.
17. Результаты исследования OCEAN (Omacor Carotid Endarterectomy Intervention Trial). XIV Международный симпозиум по атеросклерозу. Рим, 18–22 июня 2006. / Rezul'taty issledovaniia OCEAN (Omacor Carotid Endarterectomy Intervention Trial). XIV Mezhdunarodnyi simpozium po aterosklerozu. Rim, 18–22 iiunia 2006. [in Russian]
18. Eritsland J, Arnesen H, Gronseth Ket al. Effect of dietary supplementation with n-3 fatty acids on coronary artery bypass graft patency. Am J Cardiol 1996; 77: 31–6.
19. Hooper L, Thompson RL, Harrison RA et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. Br Med J 2006; 332: 752–60.
20. Harris WS, Ginsberg HN, Arunakul N et al. Safety and efficacy of Omacor in severe hypertriglyceridemia. J Cardiovasc Risk 1997; 4 (5/6): 385–91.
21. Dietary supplementation with o-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999; 354: 447–55.
22. GISSI-HF investigators. Effekt of n-3 polyunsaturated acids in patients with chronic heart failure (the GISSI-HF trial): a randomized, double-blind, placebo-controlled trial. Lancet 2008; 372: 1223.
23. Nodari S, Triggiani M, Campia U et al. Effects of n-3 polyunsaturated fatty acids on left ventricular function and functional capacity in patients with dilated cardiomyopathy. J Am Coll Cardiol 2011; 57: 870–9.
24. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Eur Heart J 2006; 27: 2099–140.
25. Leaf A et al. Membrane Effects of the n_3 Fish Oil Fatty Acids, which Prevent Fatal Ventricular Arrhythmias. J Membr Biol 2005; 206 (2): 129–39.
26. Xiao YF et al. The Antiarrhythmic Effect of n_3 Polyunsaturated Fatty Acids: Modulation of Cardiac Ion Channelsas a Potential Mechanism. J Membr Biol 2005; 206 (2): 141–54.
27. Васильев А.П., Стрельцова Н.Н., Секисова М.А. и др. Клинико-профилактические аспекты применения омега-3 жирных кислот в медицине. Тюмень: Экспресс, 2010. / Vasil'ev A.P., Strel'tsova N.N., Sekisova M.A. i dr. Kliniko-profilakticheskie aspekty primeneniia omega-3 zhirnykh kislot v meditsine. Tiumen': Ekspress, 2010. [in Russian]
28. Calo L, Biabconi L, Colivicchi F et al. N-3 fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. J Am Coll Cardiol 2005; 45: 1723–8.
29. Singer P, Wirth M. Can omega-3 polyunsaturated fatty acids reduce cardiac arrhythmias? Results of a clinical trial. Prostaglandins Leukot Essent Fatty Acids 2004; 71: 153–9.
30. Нифонтов Е.М., Шихалиев Д.Р., Богачев М.И. и др. Антиаритмическая эффективность омега-3 полиненасыщенных жирных кислот у больных стабильной ишемической болезнью сердца с желудочковыми нарушениями ритма. Кардиология. 2010; 12: 41–6. / Nifontov E.M., Shikhaliev D.R., Bogachev M.I. i dr. Antiaritmicheskaia effektivnost' omega-3 polinenasyshchennykh zhirnykh kislot u bol'nykh stabil'noi ishemicheskoi bolezn'iu serdtsa s zheludochkovymi narusheniiami ritma. Kardiologiia. 2010; 12: 41–6. [in Russian]
31. Дженкинс Н.П., Дэвидсон Н.К., Беннет Д.Г. Успешное лечение желудочковой тахикардии, рефрактерной к медикаментозной терапии, при дополнительном назначении препарата омега-3 полиненасыщенных жирных кислот. Обзоры клин. кардиологии. 2009; 18: 10–4. / Dzhenkins N.P., Devidson N.K., Bennet D.G. Uspeshnoe lechenie zheludochkovoi takhikardii, refrakternoi k medikamentoznoi terapii, pri dopolnitel'nom naznachenii preparata omega-3 polinenasyshchennykh zhirnykh kislot. Obzory klin. kardiologii. 2009; 18: 10–4. [in Russian]
32. Biscione F, Totteri A, De Vita A et al. Effect of omega-3 fatty acids on the prevention of atrial arrhythmias [in Italian]. Ital Heart J (Suppl.) 2005; 6: 53–9.
33. Chee KM, Gong JX, Rees DMG et al. Fatty acid content of marine oil capsules. Lipids 1990; 25 (9): 523–8.
34. Есинов А.В. Омега-3 жирные кислоты в медицине: диагностика, подходы к лечению. Автореф. дис. … канд. биол. наук. 2012. / Esinov A.V. Omega-3 zhirnye kisloty v meditsine: diagnostika, podkhody k lecheniiu. Avtoref. dis. … kand. biol. nauk. 2012. [in Russian]
35. Громова О.А., Торшин И.Ю., Калачева А.Г., Грачева О.Н. Мировой опыт омега-3 ПНЖК. Крупномасштабные клинические исследования омега-3 ПНЖК: об эффективности, доказательности и перспективах. Сердце. 2011; 5: 263–72. / Gromova O.A., Torshin I.Iu., Kalacheva A.G., Gracheva O.N. Mirovoi opyt omega-3 PNZhK. Krupnomasshtabnye klinicheskie issledovaniia omega-3 PNZhK: ob effektivnosti, dokazatel'nosti i perspektivakh. Serdtse. 2011; 5: 263–72. [in Russian]
________________________________________________
1. Albert CM, Campos H, Stampler MJ et al. Blood PUFAs and the risk of sudden death. N Engl J Med 2002; 346: 1113–8.
2. Mozaffarian D, Lemaitre RN, Kuller LH et al. Cardiac Benefits of Fish Consumption May Depend onthe Type of Fish Meal Consumed. Circulation 2003; 107: 1372–7.
3. Chrysohoou C, Panagiotakos DB, Pitsavos C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. J Am Coll Cardiol 2004; 44: 152–8.
4. Iso H, Rexrode KM, Stampfer MJ. Intake of fish and omega-3 fatty acids and risk of stroke in women. J Am Med Assoc 2000; 285: 304–12.
5. Shekele RB, Missell LV, Paul O et al. Fish consumption and mortality from coronary heart disease. N Engl J Med 1985; 313: 820.
6. Hu FB, Bronner L, Willett WC et al. Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 2002; 287: 1815–21.
7. Daviglus ML Stamler J, Orencia AJ et al. Fish consumption and the 30 year risk of fatal myocardial infarction. N Engl J Med 1997; 336: 1046–53.
8. Kromhout D, Bosschieter EB, Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med 1990; 7: 173–6.
9. Kris-Etherton PM. Fish consumption, fish oil, omega-3 fatty acids and cardiovasculardisease. Circulation 2002; 106: 2747–57.
10. Siscovick DS, Raghunathan TE et al. Dietary intake and cell membrane levels of long chain o3 – polyunsaturated fatty acids and the risk of primary cardiac arrest. J Am Med Assoc 1995; 274: 1363–7.
11. Keli SO et al. Fish consumption and risk of stroke: the Zutphen Study. Stroke 1994; 25: 328–32.
12. Caro J, Klittich W, McGuire A. The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin. BMJ 1997; 315: 1577–82.
13. Myerburg RJ, Spooner PM. Opportunities for sudden death prevention: Directions for new clinical and basic research. Cardiovasc Res 2001; 50: 177–85.
14. Priori G, Aliot E, Blomstrom-Lundqvist C et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J 2001; 22: 1374–450.
15. Burr ML, Fehily AM, Gilbert JF et al. Effects ofchanges in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 1989; 2 (8666): 757–61.
16. Erkkila AT, Mattman NR, Herrington DM, Lichtenstein AH. Higher plasma docosahexaenoic acid is associated with reduced progression of coronary atherosclerosis in women with CAD. J Lipid Res 2006; 47: 2814–9.
17. Rezul'taty issledovaniia OCEAN (Omacor Carotid Endarterectomy Intervention Trial). XIV Mezhdunarodnyi simpozium po aterosklerozu. Rim, 18–22 iiunia 2006. [in Russian]
18. Eritsland J, Arnesen H, Gronseth Ket al. Effect of dietary supplementation with n-3 fatty acids on coronary artery bypass graft patency. Am J Cardiol 1996; 77: 31–6.
19. Hooper L, Thompson RL, Harrison RA et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. Br Med J 2006; 332: 752–60.
20. Harris WS, Ginsberg HN, Arunakul N et al. Safety and efficacy of Omacor in severe hypertriglyceridemia. J Cardiovasc Risk 1997; 4 (5/6): 385–91.
21. Dietary supplementation with o-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999; 354: 447–55.
22. GISSI-HF investigators. Effekt of n-3 polyunsaturated acids in patients with chronic heart failure (the GISSI-HF trial): a randomized, double-blind, placebo-controlled trial. Lancet 2008; 372: 1223.
23. Nodari S, Triggiani M, Campia U et al. Effects of n-3 polyunsaturated fatty acids on left ventricular function and functional capacity in patients with dilated cardiomyopathy. J Am Coll Cardiol 2011; 57: 870–9.
24. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Eur Heart J 2006; 27: 2099–140.
25. Leaf A et al. Membrane Effects of the n_3 Fish Oil Fatty Acids, which Prevent Fatal Ventricular Arrhythmias. J Membr Biol 2005; 206 (2): 129–39.
26. Xiao YF et al. The Antiarrhythmic Effect of n_3 Polyunsaturated Fatty Acids: Modulation of Cardiac Ion Channelsas a Potential Mechanism. J Membr Biol 2005; 206 (2): 141–54.
27. Vasil'ev A.P., Strel'tsova N.N., Sekisova M.A. i dr. Kliniko-profilakticheskie aspekty primeneniia omega-3 zhirnykh kislot v meditsine. Tiumen': Ekspress, 2010. [in Russian]
28. Calo L, Biabconi L, Colivicchi F et al. N-3 fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. J Am Coll Cardiol 2005; 45: 1723–8.
29. Singer P, Wirth M. Can omega-3 polyunsaturated fatty acids reduce cardiac arrhythmias? Results of a clinical trial. Prostaglandins Leukot Essent Fatty Acids 2004; 71: 153–9.
30. Nifontov E.M., Shikhaliev D.R., Bogachev M.I. i dr. Antiaritmicheskaia effektivnost' omega-3 polinenasyshchennykh zhirnykh kislot u bol'nykh stabil'noi ishemicheskoi bolezn'iu serdtsa s zheludochkovymi narusheniiami ritma. Kardiologiia. 2010; 12: 41–6. [in Russian]
31. Dzhenkins N.P., Devidson N.K., Bennet D.G. Uspeshnoe lechenie zheludochkovoi takhikardii, refrakternoi k medikamentoznoi terapii, pri dopolnitel'nom naznachenii preparata omega-3 polinenasyshchennykh zhirnykh kislot. Obzory klin. kardiologii. 2009; 18: 10–4. [in Russian]
32. Biscione F, Totteri A, De Vita A et al. Effect of omega-3 fatty acids on the prevention of atrial arrhythmias [in Italian]. Ital Heart J (Suppl.) 2005; 6: 53–9.
33. Chee KM, Gong JX, Rees DMG et al. Fatty acid content of marine oil capsules. Lipids 1990; 25 (9): 523–8.
34. Esinov A.V. Omega-3 zhirnye kisloty v meditsine: diagnostika, podkhody k lecheniiu. Avtoref. dis. … kand. biol. nauk. 2012. [in Russian]
35. Gromova O.A., Torshin I.Iu., Kalacheva A.G., Gracheva O.N. Mirovoi opyt omega-3 PNZhK. Krupnomasshtabnye klinicheskie issledovaniia omega-3 PNZhK: ob effektivnosti, dokazatel'nosti i perspektivakh. Serdtse. 2011; 5: 263–72. [in Russian]
Авторы
А.П.Васильев*, Н.Н.Стрельцова
Тюменский кардиологический научный центр – филиал ФГБНУ «Томский национальный исследовательский медицинский центр РАН». 625026, Россия, Тюмень, ул. Мельникайте, д. 111
*sss@cardio.tmn.ru
________________________________________________
A.P.Vasilev*, N.N.Streltsova
Tyumen Cardiology Research Center, Tomsk National Research Medical Center of the Russian Academy of Science. 625026, Russian Federation, Tiumen', ul. Mel'nikaite, d. 111
*sss@cardio.tmn.ru