cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1409Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMПрепараты ω3-полиненасыщенных жирных кислот как средство профилактики сердечно-сосудистых осложненийω3-polyunsarturated fatty acid medications in cardiovascular event preventionТалицкийК. А.TalitskyK. A.КарповЮ. А.KarpovYu. A.karpov.cardio@mtu-net.ruНИИ клинической кардиологии им. А.Л.Мясникова РКНПК Росздрава. МоскваA.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, State Federal Agency for Health and Social Development. Moscow200620122006568190Copyright © Талицкий К.А., Карпов Ю.А., 20062006Талицкий К.А., Карпов Ю.А.Talitsky K.A., Karpov Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1409

Результаты многочисленных популяционных исследований свидетельствуют о существовании обратной зависимости между содержанием ω3-полиненасыщенных жирных кислот (ω3-ПНЖК ) в рационе и риском сердечно-сосудистых заболеваний (ССЗ). Увеличение потребления ω3-ПНЖК за счет модификации диеты или применения содержащих их препаратов снижает смертность у больных ССЗ. Клиническая эффективность препарата ω3-ПНЖК Омакор® была доказана в крупнейшем, проспективном исследовании при изучении влияния ω3-ПНЖК на прогноз у больных ишемической болезнью сердца (ИБС) – GISSI-Prevenzione. 11323 больных с недавним (<3 месяцев) анамнезом инфаркта миокарда (ИМ) на фоне современной терапии, рандомизированно получали 1 г/сут. концентрата ω3-ПНЖК , либо 300 мг / сут. витамина Е (α-токоферола), либо сочетание ω3-ПНЖК и витамина Е, либо плацебо (контрольная группа). Период наблюдения в среднем составил 44±5,4 месяца. Только у больных, принимавших Омакор®, к концу исследования снизились: общая смертность на 21%, сердечно-сосудистая смертность на 30% и риск внезапной смерти (ВС) на 44% по сравнению с группой плацебо. Положительное влияние терапии ω3-ПНЖК проявилось довольно быстро: снижение общей смертности в группах ω3-ПНЖК становилось статистически значимым уже через 3 месяца наблюдения, а через 4 месяца наблюдения риск ВС достоверно уменьшался на 53%. ω3-ПНЖК оказывают плейотропное позитивное воздействие на организм, наибольшее клиническое значение имеет их способность снижать частоту ВС у больных после перенесенного ИМ.

Multiple population studies have demonstrated an inverse relationship between dietary content of ω3- polyunsaturated fatty acids (ω3-PUFA) and cardiovascular disease (CVD) risk. Increased consumption of ω3- PUFA, due to diet modification or supplement intake, was associated with decreased mortality in CVD patients. Clinical effectiveness of ω3-PUFA medication, Omacor®, was demonstrated in the largest, prospective trial on ω3-PUFA and prognosis in coronary heart disease (CHD) - GISSI-Prevenzione. In total, 11323 patients diagnosed with myocardial infarction (MI) in less then 3 previous months and receiving modern therapy, were randomized to 1 g/d of concentrated ω3-PUFA, or 300 mg/d of vitamin Е (α-tocopherol), or ω3-PUFA and vitamin E combination, or placebo (control group). Mean follow-up period lasted for 44±5,4 months. By the end of the study, only in participants receiving Omacor®, total mortality decreased by 21%, cardiovascular mortality – by 30%, and sudden death (SD) risk – by 44%, comparing to placebo group. Benefits of ω3-PUFA treatment manifested relatively early: total mortality decrease was statistically significant after 3 months, and after 4 months SD risk significantly reduced by 53%. ω3-PUFA demonstrated positive pleyotropic action, with post-IM SD rate decrease as the most important clinical effect.

ω3-полиненасыщенные жирные кислотыинфаркт миокардавнезапная смертьсердечно-сосудистые осложненияпервичная и вторичная профилактикаω3-polyunsaturated fatty acidsmyocardial infarctionsudden deathcardiovascular eventsprimary and secondary preventionReferencesКарпов Ю.А. Профилактика осложнений после перенесенного инфаркта миокарда: роль омега-3 полиненасыщенных жирных кислот. Сердце 2005; 5: 264-6.Карпов Ю.А. Профилактика осложнений после перенесенного инфаркта миокарда: роль омега-3 полиненасыщенных жирных кислот. Сердце 2005; 5: 264-6.Bang HO, Dyerberg J, Sinclair HM. The composition of the Eskimo food in Northwestern Greenland. Am J Clin Nutr 1980; 33: 2657-61.Bang HO, Dyerberg J, Sinclair HM. The composition of the Eskimo food in Northwestern Greenland. Am J Clin Nutr 1980; 33: 2657-61.Kromhout D, Bosschieter EB, de Lezenne Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. NEJM 1985; 312: 1205-9.Kromhout D, Bosschieter EB, de Lezenne Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. NEJM 1985; 312: 1205-9.Siscovick DS, Raghunathan TE, King I, et al. Dietary intake and cell membrane levels of long chain n3- polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995; 274(17): 1363-7.Siscovick DS, Raghunathan TE, King I, et al. Dietary intake and cell membrane levels of long chain n3- polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995; 274(17): 1363-7.Albert CM, Campos H, Stampfer MJ, et al. Blood levels of long chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002; 346(15): 1113-8.Albert CM, Campos H, Stampfer MJ, et al. Blood levels of long chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002; 346(15): 1113-8.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(15): 1046-53.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(15): 1046-53.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(14): 1815-21.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(14): 1815-21.Keli SO, Feskens EJ, Kromhout D. Fish consumption and risk of stroke: the Zutphen Study. Stroke 1994; 25: 328-32.Keli SO, Feskens EJ, Kromhout D. Fish consumption and risk of stroke: the Zutphen Study. Stroke 1994; 25: 328-32.Ascherio A, Rimm EB, Giovannucci EL, et al. Dietary fat and risk of coronary heart disease in men: cohort study in the United States. BMJ 1996; 313(7049): 84-90.Ascherio A, Rimm EB, Giovannucci EL, et al. Dietary fat and risk of coronary heart disease in men: cohort study in the United States. BMJ 1996; 313(7049): 84-90.Williams CM, Burdge G. Long-chain n-3 PUFA: plant v. marine sources. Proc Nutr Soc 2006; 65(1): 42-50.Williams CM, Burdge G. Long-chain n-3 PUFA: plant v. marine sources. Proc Nutr Soc 2006; 65(1): 42-50.Natvig H, Borchgrevink CF, Dedichen J, et al. A controlled trial of the effect of linolenic acid on the incidence of coronary artery disease. The Norwegian vegetable oil experiment of 1965-66. Scand J Clin Lab Invest Suppl 1968; 105(Suppl): 1-20.Natvig H, Borchgrevink CF, Dedichen J, et al. A controlled trial of the effect of linolenic acid on the incidence of coronary artery disease. The Norwegian vegetable oil experiment of 1965-66. Scand J Clin Lab Invest Suppl 1968; 105(Suppl): 1-20.Bemelmans WJ, Broer J, Feskens EJ, et al. Effect of increased intake of alpha-linolenic acid and group nutritional education on cardiovascular risk factors: the Mediterranean Alpha-linolenic Enriched Groningen Dietary Intervention (MARGARIN) Study. Am J Clin Nutr 2002; 75(2): 221-7.Bemelmans WJ, Broer J, Feskens EJ, et al. Effect of increased intake of alpha-linolenic acid and group nutritional education on cardiovascular risk factors: the Mediterranean Alpha-linolenic Enriched Groningen Dietary Intervention (MARGARIN) Study. Am J Clin Nutr 2002; 75(2): 221-7.Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 1989; 2(8666): 757-61.Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 1989; 2(8666): 757-61.de Lorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999; 99(6): 779-85.de Lorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999; 99(6): 779-85.Marchioli R, Barzi F, Bomba E, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’ Infarto Miocardico (GISSI)-Prevenzione. Circulation 2002; 105(16): 1897-903.Marchioli R, Barzi F, Bomba E, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’ Infarto Miocardico (GISSI)-Prevenzione. Circulation 2002; 105(16): 1897-903.Eritsland J, Arnesen H, Gronseth K, et al. Effect of dietary supplementation with n-3 fatty acids on coronary artey bypass grafts patency. Am J Cardiol 1996; 77(1): 31-6.Eritsland J, Arnesen H, Gronseth K, et al. Effect of dietary supplementation with n-3 fatty acids on coronary artey bypass grafts patency. Am J Cardiol 1996; 77(1): 31-6.Gapinski JP, VanRuiswyk JN, Heudebert GR, Schectman GS. Preventing restenosis with fish oils following coronary angioplasty: a meta-analysis. Arch Intern Med 1993; 153(13): 1595-601.Gapinski JP, VanRuiswyk JN, Heudebert GR, Schectman GS. Preventing restenosis with fish oils following coronary angioplasty: a meta-analysis. Arch Intern Med 1993; 153(13): 1595-601.Billman GE, Kang JX, Leaf A. Prevention of ischemia-induced sudden cardiac death by pure n-3 polyunsaturated fatty acids. Lipids 1997; 32(11): 1161-8.Billman GE, Kang JX, Leaf A. Prevention of ischemia-induced sudden cardiac death by pure n-3 polyunsaturated fatty acids. Lipids 1997; 32(11): 1161-8.Leaf A, Xiao YF, Kang JX, Billman GE. Membrane Effects of the n-3 Fish Oil Fatty Acids, which Prevent Fatal Ventricular Arrhythmias. J Membr Biol 2005; 206(2): 129-39.Leaf A, Xiao YF, Kang JX, Billman GE. Membrane Effects of the n-3 Fish Oil Fatty Acids, which Prevent Fatal Ventricular Arrhythmias. J Membr Biol 2005; 206(2): 129-39.Xiao YF, Sigg DS, Leaf A. The Antiarrhythmic Effect of n3 Polyunsaturated Fatty Acids: Modulation of Cardiac Ion Channels as a Potential Mechanism. J Membr Biol 2005; 206(2): 141-54.Xiao YF, Sigg DS, Leaf A. The Antiarrhythmic Effect of n3 Polyunsaturated Fatty Acids: Modulation of Cardiac Ion Channels as a Potential Mechanism. J Membr Biol 2005; 206(2): 141-54.Christensen JH, Gustenhoff P, Korup E, et al. Effect of fish oil on heart rate variability in survivors of myocardial infarction: a double blind randomized controlled trial. BMJ 1996; 312(7032): 677-8.Christensen JH, Gustenhoff P, Korup E, et al. Effect of fish oil on heart rate variability in survivors of myocardial infarction: a double blind randomized controlled trial. BMJ 1996; 312(7032): 677-8.Kleiger RE, Miller JP, Bigger JT, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987; 59(4): 256-62.Kleiger RE, Miller JP, Bigger JT, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987; 59(4): 256-62.Calo L, Bianconi L, Colivicchi F, et al. N-3 fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. JACC 2005; 45: 1723-8.Calo L, Bianconi L, Colivicchi F, et al. N-3 fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. JACC 2005; 45: 1723-8.Sellmayer A, Witzgall H, Lorenz RL, Weber PC. Effects of dietary fish oil on ventricular premature complexes. Am J Cardiol 1995; 76(12): 974-7.Sellmayer A, Witzgall H, Lorenz RL, Weber PC. Effects of dietary fish oil on ventricular premature complexes. Am J Cardiol 1995; 76(12): 974-7.Raitt M, Connor WE, Morris C, et al. Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized, controlled trial. JAMA 2005; 293(23): 2884-91.Raitt M, Connor WE, Morris C, et al. Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized, controlled trial. JAMA 2005; 293(23): 2884-91.Harris WS. N-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr 1997; 65(5 Suppl): 1645S-54.Harris WS. N-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr 1997; 65(5 Suppl): 1645S-54.Harris WS. Nonpharmacological management of hypertriglyceridemia: focus on fish oils. Clin Cardiol 1999; 22(Suppl II): II40-3.Harris WS. Nonpharmacological management of hypertriglyceridemia: focus on fish oils. Clin Cardiol 1999; 22(Suppl II): II40-3.Bhatnagar D, Mackness MI, Durrington P, et al. Treatment of mized hyperlipidemia using a combination of omega-3 fatty acids and HMG CoA reductase inhibitor. Eur Heart J 2001; 3(Suppl D): D53-9.Bhatnagar D, Mackness MI, Durrington P, et al. Treatment of mized hyperlipidemia using a combination of omega-3 fatty acids and HMG CoA reductase inhibitor. Eur Heart J 2001; 3(Suppl D): D53-9.Yokoyama M, Origasa H; JELIS Investigators. Effects of eicosapentaenoic acid on cardiovascular events in Japanese patients with hypercholesterolemia: rationale, design, and baseline characteristics of the Japan EPA Lipid Intervention Study (JELIS). Am Heart J 2003; 146(4): 613-20.Yokoyama M, Origasa H; JELIS Investigators. Effects of eicosapentaenoic acid on cardiovascular events in Japanese patients with hypercholesterolemia: rationale, design, and baseline characteristics of the Japan EPA Lipid Intervention Study (JELIS). Am Heart J 2003; 146(4): 613-20.von Schacky C, Angerer P, Kothny W, et al. The effect of dietary omega-3 fatty acids on coronary aterosclerosis: a randomized, double-blinded, placebo-controlled trial. Ann Intern Med 1999; 130(7): 554-62.von Schacky C, Angerer P, Kothny W, et al. The effect of dietary omega-3 fatty acids on coronary aterosclerosis: a randomized, double-blinded, placebo-controlled trial. Ann Intern Med 1999; 130(7): 554-62.Kris-Etherton PM, Harris WS, Appel LJ; American Heart Association. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002; 106(21): 2747-57.Kris-Etherton PM, Harris WS, Appel LJ; American Heart Association. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002; 106(21): 2747-57.

The authors declare that there are no conflicts of interest present.