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Fatty Acids May Protect against Cardiovascular Disease: Presented at AHA

By Charlene Laino

DALLAS, TX -- November 21, 2005 -- High doses of eicosapentaenoic acid (EPA), an omega 3 fatty acid, may help protect against myocardial infarction (MI), angina, and other coronary events in patients with hypercholesterolemia and a history of coronary disease, Japanese researchers report.

Mitsuhiro Yokoyama, MD, Chief, Cardiovascular and Respiratory Medicine, Kobe University Graduate School of Medicine, Kope, Japan, presented the findings here on November 14^th at the American Heart Association Scientific Sessions 2005 (AHA).

In the Japan EPA Lipid Intervention Study (JELIS), researchers randomized 18,645 men and women who were taking pravastatin or simvastatin for hypercholesterolemia to 1,800 mg/day of EPA or placebo.

At baseline, 20% of patients in both arms had coronary artery disease, and total cholesterol was 275 mg/dL in both groups. Mean low-density lipoprotein (LDL) cholesterol was 181 mg/dL among the 9326 participants in the EPA arm and 182 mg/dL among the 9319 participants in the control group.

After 4.5 years of follow-up, patients taking EPA were 19% less likely to have adverse coronary events compared to controls (P = .01).

Overall, 2.8% of participants taking EPA had adverse events versus 3.5% in the control group. Adverse events included sudden cardiac death, fatal or non-fatal MI, unstable angina, and revascularization.

Further analysis showed that only the 3664 subjects with a history of heart disease benefited from the use of EPA. Among subjects with history of coronary disease, 8.7% of the 1823 patients on EPA had adverse events compared to 10.7% of 1841 controls. This was equivalent to a 19% risk reduction in those taking EPA, which reached significance at the P =.01 level, Dr. Yokoyama reported.

Among the 14,981 subjects with no history of heart disease, there was an insignificant 18% risk reduction associated with EPA, he said..

"Omega-3 fatty acids have powerful benefits in preventing adverse outcomes compared with statins alone," Dr. Yokoyama said. "They are particularly effective for secondary prevention."

Dr. Yokoyama said the omega-3 fatty acid seems to have a variety of protective benefits, including anti-thrombotic effects and triglyceride-lowering effects that go beyond cholesterol lowering.

"LDL cholesterol was reduced by about the same amount in both arms of the study -- 26% -- yet EPA therapy lowered cardiovascular risk significantly more," he said.

Lawrence Appel, MD, Professor of Medicine, Johns Hopkins University, Baltimore, Maryland, United States, and an American Heart Association spokesman, said, "The study reinforces the benefits of fish oil in a high-risk population with prior cardiovascular disease."

But he said he would worry that the high dose of omega-3 fatty acids used in this study could have toxic effects. "Eighteen hundred milligrams of highly purified EPA in capsule form per day is roughly 10 times the dose you get in a typical capsule. Ten tablets a day could cause a lot of side effects," he said.

But Dr. Yokoyama said that side effects, including nausea, diarrhea, rash, and itching, were mild in patients taking EPA.


[Presentation title: Effects of Eicosapentaenoic Acid (EPA) on Major Cardiovascular Events in Hypercholesterolemia Patients: The Japan EPA Lipid Intervention Study (JELIS). Latebreaker abstract]

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