Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JEllS): a randomised openlabel, blinded endpoint analysis  

Oleh:

Mitsuhiro, Yokoyama ; Origasa, Hideki ; Matsuzaki, Masunori ; Matsuzawa, Yuji ; Saito, Yasushi ; Ishikawa, Yuichi ; Oikawa, Shinichi ; Sasaki, Junnosuke ; Hishida, Hitoshi ; Itakura, Hiroshige ; Kita, Toru ; Kitabatake, Akira ; Nakaya, Noriaki ; Sakata, Toshiie ; Shimada, Kazuyuki ; Shirato, Kunio

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The Lancet (keterangan: ada di Proquest) vol. 369 no. 9567 (Mar. 2007), page 1090.

Ketersediaan

Perpustakaan FK Nomor Panggil: L01.K.2007.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background Epidemiological and clinical evidence suggests that an increased intake of long-chain n-3 fatty acids protects against mortality from coronary artery disease. We aimed to test the hypothesis that long-term use of eicosapentaenoic acid (EP A) is effective for prevention of major coronary events in hypercholesterolaemic patients in Japan who consume a large amount of fish. Methods 18645 patients with a total cholesterol of 6.5 mmolfL or greater were recruited from local physicians throughout Japan between 1996 and 1999. Patients were randomly assigned to receive either 1800 mg ofEPA daily with statin (EP A group; n=9326) or statin only (controls; n=9319) with a 5-year follow-up. The primary endpoint was any major coronary event, including sudden cardiac death, fatal and non-fatal myocardial infarction, and other nonfatal events including unstable angina pectoris, angioplasty, stenting, or coronary artery bypass grafting. Analysis was by intention-to-treat. The study was registered at clinicaltrials.gov, number NCT00231738. Findings At mean follow-up of 4.6 years, we detected the primary endpoint in 262 (2.8%) patients in the EP A group and 324 (3.5%) in controls-a 19% relative reduction in major coronary events (p=O.Oll). Post-treatment LDL cholesterol concentrations decreased 25%, from 4.7 mmolfL in both groups. Serum LDL cholesterol was not a significant factor in a reduction of risk for major coronary events. Unstable angina and non-fatal coronary events were also significantly reduced in the EP A group. Sudden cardiac death and coronary death did not differ between groups. In patients with a history of coronary artery disease who were given EP A treatment, major coronary events were reduced by 19% (secondary prevention subgroup: 158 [8.7%] in the EPA group vs 197 [10.7%] in the control group; p=0.048). In patients with no history of coronary artery disease, EP A treatment reduced major coronary events by 18%, but this finding was not significant (104 [1.4%] in the EP A group vs 127 [1.7%] in the control group; p=O .132). Interpretation EP A is a promising treatment for prevention of major coronary events, and especially non-fatal coronary events, in Japanese hypercholesterolaemic patients.

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