BackgroundHabitual intake of long‐chain omega‐3 fatty acids, especially eicosapentaenoic and docosahexaenoic acid (EPA+DHA) from fish, has been associated with a lower risk of fatal coronary heart disease (CHD) in population‐based studies. Whether that is also the case for patients with CHD is not yet clear. We studied the associations of dietary and circulating EPA+DHA and alpha‐linolenic acid, a plant‐derived omega‐3 fatty acids, with long‐term mortality risk after myocardial infarction.Methods and ResultsWe analyzed data from 4067 Dutch patients with prior myocardial infarction aged 60 to 80 years (79% men, 86% on statins) enrolled in the Alpha Omega Cohort from 2002 to 2006 (baseline) and followed through 2018. Baseline intake of fish and omega‐3 fatty acids were assessed through a validated 203‐item food frequency questionnaire and circulating omega‐3 fatty acids were assessed in plasma cholesteryl esters. Hazard ratios (HRs) with 95% CIs were obtained from Cox regression analyses. During a median follow‐up period of 12 years, 1877 deaths occurred, of which 515 were from CHD and 834 from cardiovascular diseases. Dietary intake of EPA+DHA was significantly inversely associated with only CHD mortality (HR, 0.69 [0.52–0.90] for >200 versus ≤50 mg/d; HR, 0.92 [0.86–0.98] per 100 mg/d). Similar results were obtained for fish consumption (HR_CHD, 0.74 [0.53–1.03] for >40 versus ≤5 g/d; P_trend: 0.031). Circulating EPA+DHA was inversely associated with CHD mortality (HR, 0.71 [0.53–0.94] for >2.52% versus ≤1.29%; 0.85 [0.77–0.95] per 1‐SD) and also with cardiovascular diseases and all‐cause mortality. Dietary and circulating alpha‐linolenic acid were not significantly associated with mortality end points.ConclusionsIn a cohort of Dutch patients with prior myocardial infarction, higher dietary and circulating EPA+DHA and fish intake were consistently associated with a lower CHD mortality risk.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03192410.

中文翻译：

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膳食和循环长链 Omega-3 多不饱和脂肪酸与心肌梗塞后的死亡风险：Alpha Omega 队列的长期随访

背景在基于人群的研究中，习惯性摄入长链 omega-3 脂肪酸，尤其是来自鱼类的二十碳五烯酸和二十二碳六烯酸 (EPA+DHA)，与降低致死性冠心病 (CHD) 的风险有关。尚不清楚冠心病患者是否也是如此。我们研究了饮食和循环 EPA+DHA 和 α-亚麻酸（一种植物来源的 omega-3 脂肪酸）与心肌梗死后长期死亡风险的关系。方法和结果我们分析了来自 4067 名既往心肌梗死的荷兰患者的数据60 至 80 岁（79% 为男性，86% 服用他汀类药物）从 2002 年至 2006 年（基线）参加了 Alpha Omega 队列（基线），并一直持续到 2018 年。通过经过验证的 203 项食物频率问卷评估鱼和 omega-3 脂肪酸的基线摄入量，并在血浆胆固醇酯中评估循环 omega-3 脂肪酸。从 Cox 回归分析中获得具有 95% CI 的风险比 (HR)。在 12 年的中位随访期内，共有 1877 人死亡，其中 515 人死于冠心病，834 人死于心血管疾病。EPA+DHA 的膳食摄入仅与冠心病死亡率呈显着负相关（HR，0.69 [0.52–0.90]，>200 vs ≤50 mg/d；HR，0.92 [0.86–0.98]/100 mg/d）。鱼消费也获得了类似的结果（HR 其中515人来自冠心病，834人来自心血管疾病。EPA+DHA 的膳食摄入仅与冠心病死亡率呈显着负相关（HR，0.69 [0.52–0.90]，>200 vs ≤50 mg/d；HR，0.92 [0.86–0.98]/100 mg/d）。鱼消费也获得了类似的结果（HR 其中515人来自冠心病，834人来自心血管疾病。EPA+DHA 的膳食摄入仅与冠心病死亡率呈显着负相关（HR，0.69 [0.52–0.90]，>200 vs ≤50 mg/d；HR，0.92 [0.86–0.98]/100 mg/d）。鱼消费也获得了类似的结果（HR_CHD , 0.74 [0.53–1.03] 对于 >40 与 ≤5 g/d；P_趋势：0.031)。循环 EPA+DHA 与 CHD 死亡率呈负相关（HR，0.71 [0.53–0.94]，>2.52% vs ≤1.29%；0.85 [0.77–0.95]/1-SD），还与心血管疾病和全因死亡率呈负相关。饮食和循环中的α-亚麻酸与死亡率终点没有显着相关性。结论在一组既往有心肌梗塞的荷兰患者中，较高的饮食和循环 EPA+DHA 和鱼类摄入量始终与较低的 CHD 死亡风险相关。注册网址：https ://www.clinicaltrials.gov；唯一标识符：NCT03192410。