美国布列根和妇女医院哈佛医学院JoAnn E. Manson团队研究了补充海洋ω-3脂肪酸和维生素D对突发性心房颤动的影响。2021年3月16日，《美国医学会杂志》发表了该成果。

心房颤动（AF）是最常见的心律失常，发病率不断增加，并导致重大发病和死亡。据报道，海洋ω-3脂肪酸、二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）以及维生素D对AF事件既有益处，也有风险，但缺乏大规模、长期的随机试验数据。

为了探讨长期服用海洋ω-3脂肪酸和维生素D对房颤的影响，研究组进行了一项2×2析因随机临床试验的辅助研究，2011年11月至2014年3月，通过邮件直接从美国所有50个州共招募了25119名年龄在50岁及以上、既往无心血管疾病、癌症或房颤的参与者，并随访至2017年12月31日。将这些参与者随机分组后， 6272例接受EPA-DHA和维生素D3；6270例接受EPA-DHA和安慰剂；6281例接受维生素D3和安慰剂；6296例接受两种安慰剂治疗。主要结局是病历检查证实的AF事件。

25119名参与者的平均年龄为66.7岁，女性占50.8%，其中24127名（96.1%）完成了试验。在平均5.3年的治疗和随访中，900名参与者（占研究人群的3.6%）出现了房颤事件的主要结局。EPA-DHA组中有469名（3.7%）参与者发生房颤事件，安慰剂组中有431名（3.4%），差异不显著。维生素D3组中有469名（3.7%）参与者发生房颤事件，安慰剂组中有431名（3.4%），差异亦不显著。没有证据表明两种研究药物之间有相互作用。

研究结果表明，对于50岁及以上的成年人，采用EPA-DHA或维生素D3治疗，与安慰剂相比，中位随访5年以上，患者发生房颤的风险没有显著差异。

附：英文原文

Title: Effect of Marine Omega-3 Fatty Acid and Vitamin D Supplementation on Incident Atrial Fibrillation: A Randomized Clinical Trial

Author: Christine M. Albert, Nancy R. Cook, Julie Pester, M. Vinayaga Moorthy, Claire Ridge, Jacqueline S. Danik, Baris Gencer, Hasan K. Siddiqi, Chee Ng, Heike Gibson, Samia Mora, Julie E. Buring, JoAnn E. Manson

Issue&Volume: 2021/03/16

Abstract:

Importance  Atrial fibrillation (AF) is the most common heart rhythm disturbance, continues to increase in incidence, and results in significant morbidity and mortality. The marine omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and vitamin D have been reported to have both benefits and risks with respect to incident AF, but large-scale, long-term randomized trial data are lacking.

Objective  To test the effects of long-term administration of marine omega-3 fatty acids and vitamin D on incident AF.

Design, Setting, and Participants  An ancillary study of a 2 × 2 factorial randomized clinical trial involving 25119 women and men aged 50 years or older without prior cardiovascular disease, cancer, or AF. Participants were recruited directly by mail between November 2011 and March 2014 from all 50 US states and were followed up until December 31, 2017.

Interventions  Participants were randomized to receive EPA-DHA (460 mg/d of EPA and 380 mg/d of DHA) and vitamin D3 (2000 IU/d) (n=6272 analyzed); EPA-DHA and placebo (n=6270 analyzed); vitamin D3 and placebo (n=6281 analyzed); or 2 placebos (n=6296 analyzed).

Main Outcomes and Measures  The primary outcome was incident AF confirmed by medical record review.

Results  Among the 25119 participants who were randomized and included in the analysis (mean age, 66.7 years; 50.8% women), 24127 (96.1%) completed the trial. Over a median 5.3 years of treatment and follow-up, the primary end point of incident AF occurred in 900 participants (3.6% of study population). For the EPA-DHA vs placebo comparison, incident AF events occurred in 469 (3.7%) vs 431 (3.4%) participants, respectively (hazard ratio, 1.09; 95% CI, 0.96-1.24; P=.19). For the vitamin D3 vs placebo comparison, incident AF events occurred in 469 (3.7%) vs 431 (3.4%) participants, respectively (hazard ratio, 1.09; 95% CI, 0.96-1.25; P=.19). There was no evidence for interaction between the 2 study agents (P=.39).

Conclusions and Relevance  Among adults aged 50 years or older, treatment with EPA-DHA or vitamin D3, compared with placebo, resulted in no significant difference in the risk of incident AF over a median follow-up of more than 5 years. The findings do not support the use of either agent for the primary prevention of incident AF.

DOI: 10.1001/jama.2021.1489

Source: https://jamanetwork.com/journals/jama/article-abstract/2777469