Preventive Effects of Eicosapentaenoic Acid on Coronary Artery Disease in Patients With Peripheral Artery Disease - Subanalysis of the JELIS Trial -

Abstract

he Japan eicosapentaenoic acid (EPA) lipid intervention study (JELIS) was the first large-scale randomized trial that examined the preventive effects of EPA in patients with hypercholesterolemia at risk of developing coronary artery disease (CAD). A major finding of JELIS was that EPA at the daily dose of 1,800 mg significantly reduced the incidence of major coronary events (MCE) by 19% (hazard ratio 0.81, 95% confidence interval (95%CI) 0.69-0.95, P=0.011). 1 The subanalysis of JELIS showed that EPA reduced the incidence of recurrent stroke. 2 In the primary prevention group, EPA also reduced the incidence of CAD in the high-risk group. 3 Editorial p 1298Among atherosclerotic risk factors, age and total cho-

Ratio of Serum n-3 to n-6 Polyunsaturated Fatty Acids and the Incidence of Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention

“…6, 35 Taken together, these previous reports and the present data indicate that individuals at high risk for atherosclerotic disease, such as patients who undergo PCI, have a propensity for lower serum EPA and disturbed EPA/AA ratio. Consequently, giving EPA to this high-risk population would increase serum EPA level and EPA/AA ratio, resulting in improved clinical outcome.…”

Eicosapentaenoic Acid as the Gold Standard for Patients With Peripheral Artery Disease?

“…This PAD subgroup analysis of JELIS also did not reach statistical significance in severe endpoints such as sudden cardiac death (81% reduction, P=0.099) or interventions (60% reduction, P=0.064). 1 Overall, the suppressive effect reported in that study is remarkable, with a 55% reduction in the PAD population compared with an 18% reduction in patients without PAD, and an NNT of 11. 1 With such a high prevention rate for MCE, EPA treatment will have the potential to become the standard treatment for dyslipidemia in Japanese patients with PAD.…”

“…In this issue of the Journal Ishikawa et al have reported clinically significant data out of a subgroup analysis of the JELIS trial. 1 The primary endpoint of JELIS was a major coronary event (MCE), including sudden cardiac death, fatal and non-fatal myocardial infarction, unstable angina, angioplasty/stenting or coronary bypass grafting. In the subgroup analysis of JELIS, the investigators tested two central hypotheses: whether the incidence of MCE was higher in patients with PAD and whether the EPA prevented the incidence of MCE in patients with PAD.…”

Relationship between Arteriosclerosis Obliterans and the Ratio of Serum Eicosapentaenoic Acid to Arachidonic Acid

“…7) Both JELIS and the subgroup analysis suggest that there is likely an association between PAD, ASO, and EPA. However, the direct relationship between ASO and EPA remains unclear.…”