JACC:77万人数据:抗氧化饮食并不能降低冠心病风险!

2021-01-09 MedSci原创 MedSci原创

该研究的证据并不支持高水平抗氧化剂膳食的对CHD风险的保护作用

冠心病(CHD)是全球最主要的死亡原因之一,每年在美国和欧洲分别造成约36万和178万的死亡。CHD危险因素包括吸烟、缺乏运动、营养不当、超重和肥胖、高血脂、高血压、糖尿病和睡眠不足/长眠等,而针对改善这些危险因素的干预措施能显著降低CHD风险。

除了上述传统的危险因素外,氧化应激也被认为是促进CHD发展的重要组成部分。因此,抗氧化剂、清除自由基以减少氧化应激诱导的损害被认为是初级CHD预防的关键。由于饮食是关系到日常且最好可调控的因素,因此膳食中的抗氧化剂,尤其是维生素E和C以及类胡萝卜素等被认为是最容易获得的抗氧化物质。

基于这一假设,人们进行了大量的研究来探讨抗氧化剂与原发性CHD之间的关系。在多项观察性研究中,无论是膳食成分、补充剂的摄入量,还是血液中维生素E和C以及类胡萝卜素的浓度,都与降低原发性CHD的风险有关。

然而,令人遗憾的是,许多抗氧化剂预防冠心病的临床试验都没成功。让人不禁想问,究竟问题的答案是什么?是选的抗氧剂种类不对?剂量不够?使用时间不够长?分析方法有问题?还是,抗氧化成份其实和冠心病并没有关系?

来自荷兰莱顿大学医学中心的专家团队怀疑可能与观察性研究证据不足有关。为此,该团队利用2个样本孟德尔随机化(MR)研究,评估了抗氧化饮食与原发性CHD风险之间可能的因果关系。相关结果发表在最新的心脏病学顶刊《美国心脏病学学会杂志》(Journal of the American College of CardiologyJACC)杂志上。

该研究的数据主要从3个数据库中获得:CARDIoGRAMplusC4D联盟(60801例;123504名对照受试者)、英国生物库(25306例;462011名对照受试者)和FinnGen研究(7123例;89376名对照受试者)。共计768121名受试者。研究人员首先从已发表的数据中检索循环抗氧化剂(包括维生素E和C、视黄醇、β-胡萝卜素和番茄红素)的单核苷酸多态性,评估其绝对水平和代谢物,并将其作为遗传工具变量。然后对每个暴露因素,按结果数据库进行MR分析,随后进行元分析。

结果显示,总的来说,基因预测的循环中抗氧化物质与CHD风险之间没有因果关系。对于绝对抗氧化剂,每增加ln-转化单位的抗氧化剂值,CHD的OR值在视黄醇和β-胡萝卜素分别为0.94(95%CI:0.63~1.41)和1.03(95%CI:0.97~1.10)之间。

进一步分析显示,对于代谢物,水平每增加10倍,γ-生育酚与抗坏血酸的OR值分别为0.93(95% CI:0.82~1.06)和1.01(95% CI:0.95~1.08)。

不过,同期发表的评论中,有学者认为,这项研究并不是否定了氧化应激在动脉粥样硬化发展过程中的作用,需要进一步研究的是,是否存在一种未知的抗氧化物质,能够通过改变脂蛋白修饰来干预发病,从而获得临床益处。

综上,该研究的证据并不支持高水平抗氧化剂膳食的对CHD风险的保护作用。因此,服用抗氧化剂提高血液中抗氧化剂水平对预防原发性CHD可能意义不大。

 

参考文献:

Jiao L, et al. Diet-Derived Circulating Antioxidants and Risk of Coronary Heart Disease: A Mendelian Randomization Study. J Am Coll Cardiol. 2021 Jan, 77 (1) 45–54

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    2021-06-23 hbwxf
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    2021-01-10 月夜沐歌

    还需要进一步的研究呀

    0