Saturday, April 07, 2007
fish oil
Fish oil bolsters statin reduction of coronary events
30 March 2007
The fish oil eicosapentaenoic acid (EPA) could offer extra cardioprotection in people taking statins, a study from Japan reveals.
Mitsuhiro Yokoyama (Kobe University Graduate School of Medicine, Japan) and colleagues report a 19% relative reduction in major coronary events among hypercholesterolemic patients taking EPA in addition to a statin compared with those taking a statin alone.
Epidemiologic and clinical evidence shows that increased intake of long-chain n-3 polyunsaturated fatty acids - especially EPA and docosahexanoic acid (DHA), which are found in fish and fish oil - protects against mortality from coronary artery disease.
Yokohama and team examined whether adding EPA to conventional statin treatment could yield an incremental benefit in patients in the Japan EPA Lipid Intervention Study (JELIS).
The study included 18,645 patients with a total cholesterol level of ≥6.5 mmol/l (251 mg/dl) who were randomly assigned to receive either 1800 mg EPA daily on top of a statin, or a statin alone. All patients received either 10 mg pravastatin or 5 mg simvastatin. This was increased to 20 mg or 10 mg, respectively, if a patient's lipid levels remained uncontrolled at the lower dose.
After a mean follow-up period of 4.6 years, the primary endpoint of any major coronary event, including sudden cardiac death, fatal and nonfatal myocardial infarction, and other nonfatal events occurred in 262 (2.8%) of the patients who took EPA compared with 324 (3.5%) of those who took a statin only.
This translated into a hazard ratio (HR) of 0.81 for the primary endpoint in EPA-treated patients relative to the statin-only group (p=0.011). The benefit was not tied to low-density lipoprotein cholesterol levels, the authors note in The Lancet.
Unstable angina and nonfatal coronary events were also significantly less frequent in the EPA group, at respective HRs of 0.76 (p=0.014) and 0.81 (p=0.015). Sudden cardiac death and coronary death rates did not differ significantly between the groups, however.
Further analysis showed that patients with a history of coronary artery disease (CAD) who took EPA also had a 19% lower relative risk of the primary endpoint than those who took a statin only (8.7% vs 10.7%, HR=0.81; p=0.048).
Among those with no history of CAD, there was an 18% reduction in the primary endpoint with EPA, but this was not a significant difference (1.4% vs 1.7%).
"The beneficial effects of EPA could have stemmed from many biological effects that lead to the attenuation of thrombosis, inflammation, and arrhythmia in addition to a reduction of triglycerides," say Yokoyama et al.
The researchers caution that because the patients were exclusively Japanese, they cannot generalize the results to other populations.
"We need to investigate whether EPA is effective for prevention of major coronary events in hypercholesterolemic patients without or with CAD in other countries," they conclude.
Lancet 2007; 369: 1090-1098
© Copyright Current Medicine Group Ltd, 2006
30 March 2007
The fish oil eicosapentaenoic acid (EPA) could offer extra cardioprotection in people taking statins, a study from Japan reveals.
Mitsuhiro Yokoyama (Kobe University Graduate School of Medicine, Japan) and colleagues report a 19% relative reduction in major coronary events among hypercholesterolemic patients taking EPA in addition to a statin compared with those taking a statin alone.
Epidemiologic and clinical evidence shows that increased intake of long-chain n-3 polyunsaturated fatty acids - especially EPA and docosahexanoic acid (DHA), which are found in fish and fish oil - protects against mortality from coronary artery disease.
Yokohama and team examined whether adding EPA to conventional statin treatment could yield an incremental benefit in patients in the Japan EPA Lipid Intervention Study (JELIS).
The study included 18,645 patients with a total cholesterol level of ≥6.5 mmol/l (251 mg/dl) who were randomly assigned to receive either 1800 mg EPA daily on top of a statin, or a statin alone. All patients received either 10 mg pravastatin or 5 mg simvastatin. This was increased to 20 mg or 10 mg, respectively, if a patient's lipid levels remained uncontrolled at the lower dose.
After a mean follow-up period of 4.6 years, the primary endpoint of any major coronary event, including sudden cardiac death, fatal and nonfatal myocardial infarction, and other nonfatal events occurred in 262 (2.8%) of the patients who took EPA compared with 324 (3.5%) of those who took a statin only.
This translated into a hazard ratio (HR) of 0.81 for the primary endpoint in EPA-treated patients relative to the statin-only group (p=0.011). The benefit was not tied to low-density lipoprotein cholesterol levels, the authors note in The Lancet.
Unstable angina and nonfatal coronary events were also significantly less frequent in the EPA group, at respective HRs of 0.76 (p=0.014) and 0.81 (p=0.015). Sudden cardiac death and coronary death rates did not differ significantly between the groups, however.
Further analysis showed that patients with a history of coronary artery disease (CAD) who took EPA also had a 19% lower relative risk of the primary endpoint than those who took a statin only (8.7% vs 10.7%, HR=0.81; p=0.048).
Among those with no history of CAD, there was an 18% reduction in the primary endpoint with EPA, but this was not a significant difference (1.4% vs 1.7%).
"The beneficial effects of EPA could have stemmed from many biological effects that lead to the attenuation of thrombosis, inflammation, and arrhythmia in addition to a reduction of triglycerides," say Yokoyama et al.
The researchers caution that because the patients were exclusively Japanese, they cannot generalize the results to other populations.
"We need to investigate whether EPA is effective for prevention of major coronary events in hypercholesterolemic patients without or with CAD in other countries," they conclude.
Lancet 2007; 369: 1090-1098
© Copyright Current Medicine Group Ltd, 2006
# posted by roodbont @ 12:24 PM 
