Effects of eicosapentaenoic acid on majory coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis
Reference:
Yokoyama M., et al., Lancet, 369: 1090-1098 (2007).
KobeUniversity, Kobe, Japan. Biostatistics, Toyama Univeristy, Toyama, Japan.
Summary:
This study from Japan is referred to as the JELIS – The Japan EPA Lipid Intervention Study. This long-term trial was performed on 18,645 patients with elevated blood cholesterol levels who were receiving pharmaceutical statin treatment for blood cholesterol-lowering. The patient population included both those without and with a history of coronary artery disease (CAD). In this randomized open-label, blinded end- point analysis, patients were assigned to receive either no omega-3 supplementation (controls) or daily supplementation with an EPA concentrate providing 1800mg of EPA daily over the 4.6 years of follow-up.
There was a statistically-significant reduction in major coronary events in all patients combined over the 4.6 year period with EPA supplementation (given in addition to standard statin therapy). Patients with a history of CAD also showed a statistically-significant reduction in major coronary events on follow-up of 19% whereas the patients without a history of CAD did not show statistical significance (despite an average overall trend towards reduction in major coronary events of 18%). In patients with a history of CAD, EPA supplementation reduced the risk of unstable angina and non-fatal myocardial infarctions (heart attacks) by 18% and 30% respectively.
The authors conclude that the fish/ fish oil derived fatty acid as EPA offers a promising treatment for the prevention of major coronary events and particularly non fatal coronary events in hypercholesterolemic Japanese patients receiving statin treatment for blood cholesterol control.
This important study from Japan indicated the potential for EPA supplementation to significantly reduce major coronary events in statin-treated hypercholesterolaemic patients. It is of importance to point out that the basal Japanese diet typically is a diet which is relatively high in fish with EPA/DHA (combined) intakes in the rage of 600-1000 mg/day which is much higher than the typical North American diet where the combined EPA/DHA intakes are in the range 130-150 mg/day. Future studies which directly compare concentrates of EPA versus DHA versus mixtures of EPA/DHA will be of interest to determine if any particular differences in benefit are afforded to this group of patients as compared to that demonstrated herein with EPA alone.