The role of omega-3 polyunsaturated fatty acids (PUFAs) in primary and secondary prevention on major cardiovascular events (MCE) is inconclusive due to the potential heterogeneity in study designs of formulas, dosages, and ratios of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from the findings of previous randomized controlled trials (RCTs). Here we conducted a comprehensive narrative review of pre-clinical studies and updated a network meta-analysis (NMA) to determine the comparative efficacy against MCE with different EPA/DHA dosages and formulas. We found that pure EPA was ranked the best option in the secondary prevention (hazard ratio: 0.72, 95% confidence interval: 0.65 to 0.81) from the NMA of 39 RCTs with 88,359 participants. There was no evidence of omega-3 PUFAs' efficacy in primary prevention. The mechanisms of omega-3 PUFAs' cardiovascular protection might link to the effects of anti-inflammation and stabilization of endothelial function from PUFA's derivatives including eicosanoids and the special pre-resolving mediators (SPMs).

由于二十碳五烯酸 (EPA) 和二十二碳六烯酸的配方、剂量和比例的研究设计存在潜在异质性，因此 omega-3 多不饱和脂肪酸 (PUFA) 在主要心血管事件 (MCE) 的一级和二级预防中的作用尚无定论(DHA) 来自先前随机对照试验 (RCT) 的结果。在这里，我们对临床前研究进行了全面的叙述性审查，并更新了网络荟萃分析 (NMA)，以确定不同 EPA/DHA 剂量和配方对 MCE 的比较疗效。我们发现，从涉及 88,359 名参与者的 39 项随机对照试验的 NMA 中，纯 EPA 被列为二级预防的最佳选择（风险比：0.72，95% 置信区间：0.65 至 0.81）。没有证据表明 omega-3 多不饱和脂肪酸在一级预防中的功效。