EPA Plus Statin Treatment Reduces Risk of Recurrent Stroke
Readers of the PUFA Newsletter may recall the JELIS trial conducted among hypercholesterolemic patients treated with statins to lower their low-density lipoprotein cholesterol. Half the participants received 1.8 g/day of eicosapentaenoic acid (EPA) with their statin medication. Five years later, patients taking both a statin and EPA incurred significantly fewer major coronary events, such as fatal or nonfatal myocardial infarctions and cardiac-related hospital admissions. In this report, the authors conducted a subanalysis of the original 18,645 JELIS participants with respect to the incidence of stroke.
In Japan, mortality from stroke is more than twice that of US men and about 1.5 times higher for women. The risk is related mainly to hypertension and also to diabetes, hypercholesterolemia and smoking. In this analysis of the JELIS study participants, the authors investigated the occurrence of a first or subsequent stroke in both treatment groups. Overall, the incidence of stroke was low, 114 (1.3%) in the statin group and 133 (1.5%) in the statin plus EPA group. This difference between the two groups was not statistically significant.
To assess secondary prevention, the investigators examined the 5-year recurrence of stroke (for example, cerebral thrombosis, embolism or hemorrhage) in patients who had a previous stroke. There were 457 stroke patients in the control group and 485 in the EPA group. Stroke recurred in 48 controls (10.5%) and 33 EPA patients (6.8%), a significant 20% reduction in risk with EPA consumption.
This is the first study to report a significantly reduced risk of stroke recurrence with EPA. Although this investigation observed no effect of EPA on stroke prevention, one epidemiological study reported an inverse association between fish or omega-3 fatty acid consumption and the risk of stroke in women. Other epidemiological studies have not observed a relationship between fish consumption and stroke. As the authors noted, the plasma concentration of EPA (2.8 mol%) prior to supplementation was already 10-fold higher than in the US Caucasian population, yet a benefit of increased consumption was still observed. If validated in western populations with low fish consumption, this study suggests there may be substantial opportunity to lower the risk of recurrent stroke with EPA.
SOURCEL Tanaka K, Ishikawa Y, Yokoyama M, Origasa H, Matsuzaki M, Saito Y, Matsuzawa Y, Sasaki J, Oikawa S, Hishida H, Itakura H. Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; JELIS Investigators, Japan. Reduction in the recurrence of stroke by eicosapentaenoic acid for hypercholesterolemic patients: subanalysis of the JELIS trial. Stroke 2008;39:2052-2058. [PubMed]