High-EPA Fish Oil Plus Statins Help Prevent Heart Disease
At the recent American Heart Association’s Scientific Sessions 2005, Dr. Mitsuhiro Yokoyama, M.D., Ph.D., chief of the division of cardiovascular and respiratory medicine at Kobe University Graduate School of Medicine in Kobe, Japan, presented some exciting news relating to the use of EPA in preventing heart disease.
Below is the American Heart Association’s press release:
DALLAS, Nov. 14 – Cholesterol-lowering drugs, combined with a fatty acid found in fish, packs a one-two punch against heart attack, angina and other coronary events, according to a study presented at a late-breaking clinical trials session at the American Heart Association’s Scientific Sessions 2005.
“These results appear to justify the use of fish oil/omega-3 fatty acids since they can add to the beneficial effects of statins,” said lead author Mitsuhiro Yokoyama, M.D., Ph.D., chief of the division of cardiovascular and respiratory medicine at Kobe University Graduate School of Medicine in Kobe, Japan.
He presented the results of Effects of Eicosapentaenoic Acid (EPA) on Major Cardiovascular Events in Hypercholesterolemic Patients: The Japan EPA Lipid Intervention Study (JELIS). It’s the first large-scale, prospective, randomized trial that combines statins and omega-3 fatty acid therapy. EPA is one of the major omega-3 fatty acids in fish.
Of 18,645 eligible participants, 9,326 were given 1,800 milligrams (mg)/day of highly purified EPA capsules. This form of EPA has been available in Japan since 1990 for treating lipid abnormalities and peripheral artery disease (atherosclerosis in the body’s peripheral circulation in the legs).
The primary endpoint of the study was experiencing any of a group of outcomes that included sudden cardiac death, heart attack, unstable angina (sustained chest pain due to the heart’s oxygen starvation), or undergoing procedures to reopen blocked arteries, such as angioplasty/stenting or coronary artery bypass surgery.
After more than 4.5 years of follow-up, the primary endpoint was seen in 2.8 percent of patients treated with statins plus EPA compared to 3.5 percent in the statin-only group, he said.
“This represents a 19 percent reduction in risk from EPA plus statin treatment compared to statin treatment alone,” Yokayama said.
Researchers divided patients into two groups: “primary prevention” which included 14,981 people who had no history of coronary artery disease (CAD), and a “secondary prevention” group that included 3,664 subjects who had a history of CAD.
The study found that 8.7 percent of statin/EPA-treated patients in the secondary prevention group experienced one of the composite outcomes, compared to 10.7 percent of the statin-only secondary prevention group, again a 19 percent risk reduction in those getting statin plus EPA. A similar, but insignificant, trend occurred for the primary prevention analysis: 1.4 percent among those treated with statins/EPA versus 1.7 percent in those treated with statins alone for an 18 percent reduction in risk.
“The beneficial effects of EPA plus statins is more convincing in patients with coronary artery disease, as they are more prone to have major coronary events, compared to hypercholesterolemic patients without coronary artery disease,” he said.
“Epidemiological studies have demonstrated that a diet rich in long-chain polyunsaturated omega-3 fatty acids, which are abundant in fish, is protective against death and disability from coronary heart disease,” Yokoyama said. Other studies have shown statins to be similarly beneficial, prompting the current study to investigate whether their benefits might be additive.
The Japanese diet is about 40 percent fish, and heart and blood vessel disease rates are lower in Japan compared to western countries, he said. But many young Japanese eat diets similar to those of Western youth; and blood cholesterol levels among youth in the two countries are also becoming similar as well. Interestingly, this study found that the benefits of the combination therapy did not seem to be due to changes in cholesterol, Yokoyama said. Both combination and statin-only therapy reduced LDL, the so-called ‘bad’ cholesterol, by the same amount – 26 percent – yet double therapy reduced cardiovascular risk, he said. The EPA could benefit further through multiple mechanisms which might include anti-thrombotic (preventing blood clotting), anti-inflammatory or triglyceride-lowering effects, he said.
According to Robert Eckel, M.D., president of the American Heart Association, “The JELIS data continue to support the beneficial effect of omega-3 fatty acids in patients with known coronary heart disease, and now an effect that extends the benefit of statins. Moreover, there’s a hint that a similar benefit may be present in hypercholesterolemic patients without known coronary heart disease. Yet, an important consideration is that the dose of omega-3 fatty acids – 1,800 mg a day of highly purified EPA, is more than the standard over-the-counter supplement. Check with your physician first.”
Members of the JELIS steering committee: Mitsuhiro Yokoyama, M.D.; Hideki Origasa, Ph.D.; Masunori Matsuzaki, M.D.; Yuji Matsuzawa, M.D.; Yasushi Saito, M.D.; Yuichi Ishikawa, M.D.; Shinichi Oikawa, M.D.; Jun Sasaki, M.D.; Hitoshi Hishida, M.D.; Hiroshige Itakura, M.D.; Toru Kita, M.D.; Akira Kitabatake, M.D.; Noriaki Nakaya, M.D.; Toshiie Sakata, M.D;. Kazuyuki Shimada, M.D.; and Kunio Shirato, M.D. for the JELIS Investigators, Japan.
SOURCE: American Heart Association Ω