Omega-3 fatty acids (O3FAs) possess beneficial properties for cardiovascular (CV) health and elevated O3FA levels are associated with lower incident risk for CV disease (CVD.) Yet, treatment of at-risk patients with various O3FA formulations has produced disparate results in large, well-controlled and well-conducted clinical trials. Prescription formulations and fish oil supplements containing low-dose mixtures of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have routinely failed to prevent CV events in primary and secondary prevention settings when added to contemporary care, as shown most recently in the STRENGTH and OMEMI trials. However, as observed in JELIS, REDUCE-IT, and RESPECT-EPA, EPA-only formulations significantly reduce CVD events in high-risk patients. The CV mechanism of action of EPA, while certainly multifaceted, does not depend solely on reductions of circulating lipids, including triglycerides (TG) and LDL, and event reduction appears related to achieved EPA levels suggesting that the particular chemical and biological properties of EPA, as compared to DHA and other O3FAs, may contribute to its distinct clinical efficacy. In vitro and in vivo studies have shown different effects of EPA compared with DHA alone or EPA/DHA combination treatments, on atherosclerotic plaque morphology, LDL and membrane oxidation, cholesterol distribution, membrane lipid dynamics, glucose homeostasis, endothelial function, and downstream lipid metabolite function. These findings indicate that prescription-grade, EPA-only formulations provide greater benefit than other O3FAs formulations tested. This review summarizes the clinical findings associated with various O3FA formulations, their efficacy in treating CV disease, and their underlying mechanisms of action.

中文翻译：

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患者是否受益于 omega-3 脂肪酸？

Omega-3 脂肪酸 (O3FA) 具有对心血管 (CV) 健康有益的特性，并且 O3FA 水平升高与心血管疾病 (CVD) 事件风险降低相关。然而，使用各种 O3FA 配方治疗高危患者却产生了不同的结果在大型、控制良好且进行良好的临床试验中。当添加到当代护理中时，含有低剂量二十碳五烯酸 (EPA) 和二十二碳六烯酸 (DHA) 混合物的处方配方和鱼油补充剂通常无法预防一级和二级预防中的心血管事件，正如最近的 STRENGTH 和OMEMI 试验。然而，正如在 JELIS、REDUCE-IT 和 RESPECT-EPA 中观察到的，仅 EPA 配方可显着减少高危患者的 CVD 事件。EPA 的 CV 作用机制虽然肯定是多方面的，但不仅仅取决于循环脂质（包括甘油三酯 (TG) 和 LDL）的减少，并且事件减少似乎与达到的 EPA 水平有关，这表明 EPA 的特定化学和生物特性，与 DHA 和其他 O3FA 相比，可能有助于其独特的临床功效。体外和体内研究表明，与单独使用 DHA 或 EPA/DHA 联合治疗相比，EPA 对动脉粥样硬化斑块形态、LDL 和膜氧化、胆固醇分布、膜脂动力学、葡萄糖稳态、内皮功能和下游脂质代谢物有不同的影响功能。这些研究结果表明，处方级纯 EPA 配方比其他测试的 O3FA 配方具有更大的益处。本综述总结了与各种 O3FA 制剂相关的临床发现、它们治疗心血管疾病的功效及其潜在的作用机制。