ОЦЕНКА ЭФФЕКТИВНОСТИ ОМЕГА-3 ЖИРНЫХ КИСЛОТ ДЛЯ ВТОРИЧНОЙ ПРОФИЛАКТИКИ ВНЕЗАПНОЙ СЕРДЕЧНОЙ СМЕРТИ У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА: СИСТЕМАТИЧЕСКИЙ ОБЗОР И МЕТА АНАЛИЗ
Введение: Заболеваемость инфарктом миокарда продолжает расти, особенно среди лиц молодого и среднего возраста - частота возникновения в возрасте до 40 лет достигает 35%. У выживших сохраняется высокий риск повторной сосудистой катастрофы: 18% мужчин и 35% женщин в течение последующих 6 лет переносят второй инфаркт миокарда. Опыт стран, в том числе США, добившихся значительного снижения смертности от ССЗ, указывает на необходимость активно заниматься вопросами профилактики ССЗ, основанной на концепции кардиологических факторов риска. Реализация этой стратегии обусловливает необходимость активной коррекции факторов риска посредством изменения образа жизни пациентов в направлении оздоровления и диетотерапии, которая направлена на снижение потребления красного мяса с увеличением количества потребляемых морских продуктов, являющихся естественными источниками омега-3 ПНЖК.
Цель: Представленный обзор был выполнен с целью изучения профилактической роли потребления омега-3 ПНЖК внезапной сердечной смерти у пациентов после острого инфаркта миокарда с использованием моделей случайных эффектов.
Методы: Систематический обзор и мета-анализ рандомизированных контролируемых исследований из баз данных Web of Science, Pubmed и e-library по критериям включения (РКИ на английском и русском языках, без временных ограничений), был дополнен количественным синтезом в форме мета-анализа, для которого использовали модели случайных эффектов, как наиболее робастные и допускающие наличие гетерогенности результатов индивидуальных исследований. Рассчитывали взвешенный относительный риск (RR), коэффициент гетерогенности I2. Количественные результаты представляли с 95% доверительными (CI) и прогностическими (PI) интервалами.
Результаты: Взвешенный RR составил 0,83 (95% CI:0,59; 1,18), показывающий, что относительный риск внезапной сердечной смерти в группах, принимавших омега-3 жирные кислоты, был ниже, чем в контрольной группе, но результаты не достигают уровня статистической значимости. Была выявлена значительная гетерогенность результатов индивидуальных исследований (Q test = 19,50; df=4, p<0,001). Вариабельность RR индивидуальных исследований на 80% (95% CI: 51; 91) была обусловлена этой гетерогенностью согласно показателю I2. 95% прогностический интервал для RR, куда с 95% вероятностью может попасть результат нового исследования, находится в пределах 0,26-2,61.
Выводы: на основании проведенного систематического обзора и мета-анализа, можно сделать вывод о том, что доказательств профилактики внезапной сердечной смерти у пациентов, перенесших острый инфаркт миокарда от назначения источников омега-3 ПНЖК нет. В дальнейшем необходимо провести более крупные проспективные исследования для подтверждения или опровержения полученных результатов.
Раушан Ш. Тулеуова 1, https://orcid.org/0000-0002-0964-3841
Андрей М. Гржибовский 1-4, http://orcid.org/0000-0002-5464-0498
Лаззат М. Жамалиева 1, http://orcid.org/0000-0003-3625-3651
Дамира Г. Жаманкулова 1, https://orcid.org/0000-0001-6943-0664
1 Западно-Казахстанский Государственный медицинский университет имени Марата Оспанова, г. Актобе, Республика Казахстан;
2 Северо-Восточный федеральный университет им. М. К. Аммосова, г. Якутск, Российская Федерация;
3 Казахский Национальный Университет им. аль-Фараби, г. Алматы, Казахстан;
4 Северный государственный медицинский университет, г. Архангельск; Российская Федерация.
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Тулеуова Р.Ш., Гржибовский А.М., Жамалиева Л.М., Жаманкулова Д.Г. Оценка эффективности Омега-3 жирных кислот для вторичной профилактики внезапной сердечной смерти у пациентов с инфарктом миокарда: систематический обзор и мета анализ // Наука и Здравоохранение. 2019. 1 (Т.21). С. 7-20. Tuleuova R.Sh., Grjibovski A.M., Zhamaliyeva L.M., Zhamankulova D.G. Omega-3 PUFA as secondary prophylaxis of sudden cardiac death after acute myocardial infarction: systematic review and meta-analysis. Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 1, pp. 7-20. Тулеуова Р.Ш., Гржибовский А.М., Жамалиева Л.М., Жаманкулова Д.Г. Жедел жүрек инфарктісі бар науқастарда жедел жүрек өлімінің екінші профилактикасы ретінде Омега-3 май қышқылдарын пайдалану: жүйелік шолу және мета анализ // Ғылым және Денсаулық сақтау. 2019. 1 (Т.21). Б. 7-20.Похожие публикации:
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