ПРИМЕНЕНИЕ ОМЕГА-3 ПОЛИНЕНАСЫЩЕННЫХ ЖИРНЫХ КИСЛОТ В ПРОФИЛАКТИКЕ ПОСЛЕОПЕРАЦИОННОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ ПРИ КОРОНАРНОМ ШУНТИРОВАНИИ

Основные положения

Назначение омега-3 полиненасыщенных жирных кислот для профилактики послеоперационной фибрилляции предсердий при проведении коронарного шунтирования у пациентов с ишемической болезнью сердца требует тщательного анализа характеристики выборки больных с оценкой клинических, эхокардиографических параметров, факторов оперативного вмешательства, показателей воспаления, окислительного стресса. Кроме того, дозировка препарата и длительность его применения определяют влияние на риск возникновения фибрилляции предсердий. Омега-3 полиненасыщенные жирные кислоты в краткосрочной терапии уменьшают частоту новых эпизодов указанной аритмии после коронарного вмешательства, однако данное влияние нивелируется совместным применением статинов.

Резюме

В статье представлены данные литературы об эффективности применения омега-3 полиненасыщенных жирных кислот в профилактике послеоперационной фибрилляции предсердий у пациентов с ишемической болезнью сердца при проведении коронарного шунтирования. Освещены возможные механизмы антиаритмического действия препарата, включая его противовоспалительный и антиоксидантный эффекты. Обсуждаются причины снижения активности омега-3 полиненасыщенных жирных кислот при комбинированном назначении с ингибиторами ГМГ-КоА-редуктазы.

1. Tribulova N., Szeiffova Bacova B., Egan Benova T., Knezl V., Barancik M., Slezak J. Omega-3 Index and Anti-Arrhythmic Potential of Omega-3 PUFAs. Nutrients. 2017;9(11):1191; doi: 10.3390/nu9111191.

2. Golpour P., Nourbakhsh M., Mazaherioun M., Janani L., Nourbakhsh M., Yaghmaei P. Improvement of NRF2 gene expression and antioxidant status in patients with type 2 diabetes mellitus after supplementation with omega-3 polyunsaturated fatty acids: A double-blind randomised placebo-controlled clinical trial. Diabetes Res Clin Pract. 2020;162:108120. doi: 10.1016/j.diabres.2020.108120.

3. Innes J.K., Calder P.C. Omega-6 fatty acids and inflammation. Prostaglandins Leukot Essent Fatty Acids. 2018;132:41-48. doi: 10.1016/j.plefa.2018.03.004.

4. Torquato P., Giusepponi D., Alisi A., Galarini R., Bartolini D., Piroddi M., Goracci L., Di Veroli A., Cruciani G., Crudele A., Nobili V., Galli F. Nutritional and lipidomics biomarkers of docosahexaenoic acid-based multivitamin therapy in pediatric NASH. Sci Rep. 2019;9(1):2045. doi: 10.1038/s41598-018-37209-y.

5. Innes J.K., Calder P.C. Marine Omega-3 (N-3) Fatty Acids for Cardiovascular Health: An Update for 2020. Int J Mol Sci. 2020;21(4):1362. doi: 10.3390/ijms21041362.

6. Ашихмин ЯИ, Драпкина ОМ. Сократительная функция предсердий у пациентов с пароксизмальной формой фибрилляции предсердий. Кардиология. 2015;5:40-47. doi: 10.18565/cardio.2015.5.40-47.

7. Oikonomou E., Vogiatzi G., Karlis D., Siasos G., Chrysohoou C., Zografos T., Lazaros G., Tsalamandris S., Mourouzis K., Georgiopoulos G., Toutouza M., Tousoulis D. Effects of omega-3 polyunsaturated fatty acids on fibrosis, endothelial function and myocardial performance, in ischemic heart failure patients. Clin Nutr. 2019;38(3):1188-1197. doi: 10.1016/j.clnu.2018.04.017.

8. Wang H., Chen J., Zhao L. N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review. J Interv Card Electrophysiol. 2018;51(2):105-115. doi: 10.1007/s10840-018-0315-5.

9. Langlois P.L., Hardy G., Manzanares W. Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An updated systematic review and meta-analysis. Clin Nutr. 2017;36(3):737-746. doi: 10.1016/j.clnu.2016.05.013.

10. Raiten J.M., Ghadimi K., Augoustides J.G., Ramakrishna H., Patel P.A., Weiss S.J, Gutsche JT. Atrial fibrillation after cardiac surgery: clinical update on mechanisms and prophylactic strategies. J Cardiothorac Vasc Anesth. 2015;29(3):806-16. doi: 10.1053/j.jvca.2015.01.001.

11. Siscovick D.S., Barringer T.A., Fretts A.M., Wu J.H., Lichtenstein A.H., Costello R.B., Kris-Etherton P.M., Jacobson T.A., Engler M.B., Alger H.M., Appel L.J., Mozaffarian D.; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association. Circulation. 2017;135(15):e867-e884. doi: 10.1161/CIR.0000000000000482.

12. Colussi G., Catena C., Fagotto V., Darsiè D., Brosolo G., Bertin N., Sechi L.A. Atrial fibrillation and its complications in arterial hypertension: The potential preventive role of omega-3 polyunsaturated fatty acids. Crit Rev Food Sci Nutr. 2019;59(12):1937-1948. doi: 10.1080/10408398.2018.1434126.

13. Rodrigo R., Korantzopoulos P., Cereceda M., Asenjo R., Zamorano J., Villalabeitia E., Baeza C., Aguayo R., Castillo R., Carrasco R., Gormaz J.G. A randomized controlled trial to prevent post-operative atrial fibrillation by antioxidant reinforcement. J Am Coll Cardiol. 2013;62(16):1457-65. doi: 10.1016/j.jacc.2013.07.014.

14. Stanger O., Aigner I., Schimetta W., Wonisch W. Antioxidant supplementation attenuates oxidative stress in patients undergoing coronary artery bypass graft surgery. Tohoku J Exp Med. 2014;232(2):145-54. doi: 10.1620/tjem.232.145.

15. Wilbring M., Ploetze K., Bormann S., Waldow T., Matschke K. Omega-3 polyunsaturated Fatty acids reduce the incidence of postoperative atrial fibrillation in patients with history of prior myocardial infarction undergoing isolated coronary artery bypass grafting. Thorac Cardiovasc Surg. 2014;62(7):569-74. doi: 10.1055/s-0034-1371699.

16. Gu J., Lundbye-Christensen S., Eschen R.B., Andreasen A., Andreasen J.J. Marine n-3 fatty acids are incorporated into atrial tissue but do not correlate with postoperative atrial fibrillation in cardiac surgery. Vascul Pharmacol. 2016;87:70-75. doi: 10.1016/j.vph.2016.11.004.

17. Wu J.H., Marchioli R., Silletta M.G., Masson S., Sellke F.W., Libby P., Milne G.L., Brown N.J., Lombardi F., Damiano R.J.Jr., Marsala J., Rinaldi M., Domenech A., Simon C., Tavazzi L., Mozaffarian D. Oxidative Stress Biomarkers and Incidence of Postoperative Atrial Fibrillation in the Omega-3 Fatty Acids for Prevention of Postoperative Atrial Fibrillation (OPERA) Trial. J Am Heart Assoc. 2015;4(5):e001886. doi: 10.1161/JAHA.115.001886.

18. Dinesen P.T., Schmidt E.B. Marine n-3 fatty acids and the risk of new-onset postoperative atrial fibrillation after cardiac surgery. Vascul Pharmacol. 2016;87:23-25. doi: 10.1016/j.vph.2016.11.005.

19. Joss J.D., Hernan J., Collier R., Cardenas A. Perioperative supplementation of polyunsaturated omega-3 fatty acid for the prevention of atrial fibrillation after cardiothoracic surgery. Am J Health Syst Pharm. 2017;74(1):e17-e23. doi: 10.2146/ajhp150740.

20. Darghosian L., Free M., Li J., Gebretsadik T., Bian A., Shintani A., McBride B.F., Solus J., Milne G., Crossley G.H., Thompson D., Vidaillet H., Okafor H., Darbar D., Murray K.T., Stein C.M. Effect of omega-three polyunsaturated fatty acids on inflammation, oxidative stress, and recurrence of atrial fibrillation. Am J Cardiol. 2015;115(2):196-201. doi: 10.1016/j.amjcard.2014.10.022.

21. Mozaffarian D., Marchioli R., Macchia A., Silletta M.G., Ferrazzi P., Gardner T.J., Latini R., Libby P., Lombardi F., O'Gara P.T., Page R.L., Tavazzi L., Tognoni G.; OPERA Investigators. Fish oil and postoperative atrial fibrillation: the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation (OPERA) randomized trial. JAMA. 2012;308:2001–2011. doi: 10.1001/jama.2012.28733.

22. Metcalf R.G., Skuladottir G.V., Indridason O.S., Sullivan T.R., Bjorgvinsdottir L., Sanders P., Arnar D.O., Gibson R.A., Heidarsdottir R., Cleland L.G., Palsson R., Farquharson A.L., Young G.D., James M.J. U-shaped relationship between tissue docosahexaenoic acid and atrial fibrillation following cardiac surgery. Eur J Clin Nutr. 2014;68:114–118. doi: 10.1038/ejcn.2013.215.

23. Ali-Hassan-Sayegh S., Mirhosseini S.J., Rezaeisadrabadi M., Dehghan H.R., Sedaghat-Hamedani F., Kayvanpour E., Popov A.F., Liakopoulos O.J. Antioxidant supplementations for prevention of atrial fibrillation after cardiac surgery: an updated comprehensive systematic review and meta-analysis of 23 randomized controlled trials. Interact Cardiovasc Thorac Surg. 2014;18:646–654. doi: 10.1093/icvts/ivu020.

24. Zhang F., Yu H., Ni X., Zhu J., Wang S., Shen S. Effect of ω-3 polyunsaturated fatty acids on the growth of IEC-6 cells injured by heavy metals. Biomed Rep. 2016;4(5):635-641. doi: 10.3892/br.2016.621.

25. Benedetto U., Angeloni E., Melina G., Danesi T.H., Di Bartolomeo R., Lechiancole A., Refice S., Roscitano A., Comito C., Sinatra R. N-3 Polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation: a meta-analysis of randomized controlled trials. J Cardiovasc Med (Hagerstown). 2013;14:104–109. doi: 10.2459/JCM.0b013e32834a13c1.

26. Costanzo S., di Niro V., Castelnuovo A.D., Gianfagna F., Donati M.B., de Gaetano G., Iacoviello L. Prevention of postoperative atrial fibrillation in open heart surgery patients by preoperative supplementation of n-3 polyunsaturated fatty acids: an updated meta-analysis. J Thorac Cardiovasc Surg. 2013;146(4):906–911. doi: 10.1016/j.jtcvs.2013.03.015.

27. Pipingas A., Cockerell R., Grima N., Sinclair A., Stough C., Scholey A., Myers S., Croft K., Sali A., Pase M.P. Randomized controlled trial examining the effects of fish oil and multivitamin supplementation on the incorporation of n-3 and n-6 fatty acids into red blood cells. Nutrients. 2014;6:1956–1970. doi: 10.3390/nu6051956.

28. Garg P.K., Guan W., Nomura S., Weir N., Karger A.B., Duprez D., Heckbert S.R., Tsai M.Y. Plasma omega-3 and omega-6 PUFA Concentrations and Risk of Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis. J Nutr. 2021;151(6):1479-1486. doi: 10.1093/jn/nxab016.

29. Bjorgvinsdottir L., Arnar D.O., Indridason O.S., Heidarsdottir R., Skogstrand K., Torfason B., Hougaard D.M., Palsson R., Skuladottir G.V. Do high levels of n-3 polyunsaturated fatty acids in cell membranes increase the risk of postoperative atrial fibrillation? Cardiology. 2013;126(2):107-14. doi: 10.1159/000351432.

30. Macchia A., Romero M., D'Ettorre A., Tognoni G., Mariani J. Exploratory analysis on the use of statins with or without n-3 PUFA and major events in patients discharged for acute myocardial infarction: an observational retrospective study. PLoS One. 2013;8(5):e62772. doi: 10.1371/journal.pone.0062772.

31. Petersen F., Rodrigo R., Richter M., Kostin S. The effects of polyunsaturated fatty acids and antioxidant vitamins on atrial oxidative stress, nitrotyrosine residues, and connexins following extracorporeal circulation in patients undergoing cardiac surgery. Mol Cell Biochem. 2017;433(1-2):27-40. doi: 10.1007/s11010-017-3013-1.

32. de Lorgeril М., Salen P., Defaye P., Rabaeus M. Recent findings on the health effects of omega-3 fatty acids and statins, and their interactions: do statins inhibit omega-3? BMC Medicine. 2013;11:1–13. doi: 10.1186/1741-7015-11-5.

33. Saravanan P., Bridgewater B., West A.L., O'Neill S.C., Calder P.C., Davidson N.C. Omega-3 fatty acid supplementation does not reduce risk of atrial fibrillation after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial. Circ Arrhythm Electrophysiol. 2010 Feb;3(1):46-53. doi: 10.1161/CIRCEP.109.899633.

34. Nagahara Y., Motoyama S., Sarai M., Ito H., Kawai H., Takakuwa Y., Miyagi M., Shibata D., Takahashi H., Naruse H., Ishii J., Ozaki Y. Eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio as an associated factor of high risk plaque on coronary computed tomography in patients without coronary artery disease. Atherosclerosis. 2016;250:30-7. doi: 10.1016/j.atherosclerosis.2016.04.026.

35. Khandelwal S., Kelly L., Malik R., Prabhakaran D., Reddy S. Impact of omega-6 fatty acids on cardiovascular outcomes: A review. J Preventive Cardiol. 2013;2(3):325-336.

36. Choi Y.S., de Mattos A.B.M., Shao D., Li T., Nabben M., Kim M., Wang W., Tian R., Kolwicz S.C.Jr. Preservation of Myocardial Fatty Acid Oxidation Prevents Diastolic Dysfunction in Mice Subjected to Angiotensin II Infusion. J. Mol. Cell. Cardiol. 2016;100:64–71. doi: 10.1016/j.yjmcc.2016.09.001.

37. Abdukeyum G.G., Owen A.J., Larkin T.A., McLennan P.L. Up-Regulation of Mitochondrial Antioxidant Superoxide Dismutase Underpins Persistent Cardiac Nutritional-Preconditioning by Long Chain n-3 Polyunsaturated Fatty Acids in the Rat. J Clin Med. 2016;5(3):32. doi: 10.3390/jcm5030032.

38. Ramachandran R., Wierzbicki A.S. Statins, Muscle Disease and Mitochondria. J Clin Med. 2017;6(8):75. doi: 10.3390/jcm6080075.

39. Zhang Y., Zhuang P., Mao L., Chen X., Wang J., Cheng L., Ding G., Jiao J. Current level of fish and omega-3 fatty acid intakes and risk of Type 2 diabetes in China. J Nutr Biochem. 2019;74:108249. doi: 10.1016/j.jnutbio.2019.108249.

40. Ichimura A., Hirasawa A., Poulain-Godefroy O., Bonnefond A., Hara T., Yengo L. et al. Dysfunction of lipid sensor GPR120 leads to obesity in both mouse and human. Nature. 2012;483:350–354. doi: 10.1038/nature10798.

41. Golomb B.A., Evans M.A., Dimsdale J.E., White H.L. Effects of statins on energy and fatigue with exertion: results from a randomized controlled trial. Arch. Intern. Med. 2012;13:1180–1182. doi: 10.1001/archinternmed.2012.2171.

42. Dangour A.D., Andreeva V.A., Sydenham E., Uauy R.Omega-3 fatty acids and cognitive health in older people. Br. J. Nutr. 2012;107(Suppl 2):S152–S158. doi: 10.1017/S0007114512001547.

43. Gencer B., Djousse L., Al-Ramady O.T. Cook N.R., Manson J.E., Albert C.M. Effect of Long-Term Marine -3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Circulation. 2021;144(25):1981-1990. doi: 10.1161/CIRCULATIONAHA.121.055654.

44. Kalstad A.A., Myhre P.L., Laake K.. Tveit S.H., Schmidt E.B., Smith P., Nilsen D.W.T., Tveit A., Fagerland M.W., Solheim S., Seljeflot I., Arnesen H.; OMEMI Investigators. Effects of n-3 Fatty Acid Supplements in Elderly Patients After Myocardial Infarction: A Randomized, Controlled Trial. Circulation. 2021;143(6):528-539. doi: 10.1161/CIRCULATIONAHA.120.052209.

45. Nicholls S.J., Lincoff A.M., Garcia M., Bash D., Ballantyne C.M., Barter P.J., Davidson M.H., Kastelein J.J.P., Koenig W., McGuire D.K., Mozaffarian D., Ridker P.M., Ray K.K., Katona B.G., Himmelmann A., Loss L.E., Rensfeldt M., Lundström T., Agrawal R., Menon V., Wolski K., Nissen S.E. Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk: The STRENGTH Randomized Clinical Trial. JAMA. 2020;324(22):2268-2280. doi: 10.1001/jama.2020.22258.

46. Рубаненко О.А., Фатенков О.В., Хохлунов С.М. Семагин А.П., Кузнецов Д.В., Лимарева Л.В. Комбинация омега-3 полиненасыщенных жирных кислот и статинов в профилактике фибрилляции предсердий после операции коронарного шунтирования. Клиническая медицина. 2017;95(9):817–823). doi: 10.18821/0023-2149-2017-95-9-817-823.