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J Cardiol. 2017 Dec;70(6):537-544. doi: 10.1016/j.jjcc.2017.07.007. Epub 2017 Aug 31.

A randomized controlled trial of eicosapentaenoic acid in patients with coronary heart disease on statins.

Author information

1
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan. Electronic address: tewatana@med.id.yamagata-u.ac.jp.
2
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
3
Yamagata Prefectural Central Hospital, Yamagata, Japan.
4
Nihonkai General Hospital, Yamagata, Japan.
5
Okitama Public General Hospital, Yamagata, Japan.
6
Yamagata Prefectural Shinjyo Hospital, Yamagata, Japan.
7
Yamagata City Hospital Saiseikan, Yamagata, Japan.
8
Tohoku Pharmaceutical University Hospital, Miyagi, Japan.

Abstract

BACKGROUND:

There is a residual risk of coronary heart disease (CHD) despite intensive statin therapy for secondary prevention. The aim of this study was to investigate whether coronary plaque regression and stabilization are reinforced by the addition of eicosapentaenoic acid (EPA) to high-dose pitavastatin (PTV).

METHODS:

We enrolled 193 CHD patients who underwent percutaneous coronary intervention (PCI) in six hospitals. Patients were randomly allocated to the PTV group (PTV 4mg/day, n=96) or PTV/EPA group (PTV 4mg/day and EPA 1800mg/day, n=97), and prospectively followed for 6-8 months. Coronary plaque volume and composition in nonstenting lesions were analyzed by integrated backscatter intravascular ultrasound (IB-IVUS).

RESULTS:

The PTV/EPA group showed a greater reduction in total atheroma volume compared to PTV group. IB-IVUS analyses revealed that lipid volume was significantly decreased during follow-up period in only PTV/EPA group. The efficacy of additional EPA therapy on lipid volume reduction was significantly higher in stable angina pectoris (SAP) patients compared to acute coronary syndrome patients. EPA/AA ratio was significantly improved in PTV/EPA group compared to PTV group. There was no significant difference in the incidence of major adverse cardiovascular events and side effects.

CONCLUSIONS:

Combination EPA/PTV therapy significantly reduced coronary plaque volume compared to PTV therapy alone. Plaque stabilization was also reinforced by EPA/PTV therapy in particular SAP patients. The addition of EPA is a promising option to reduce residual CHD risk under intensive statin therapy.

KEYWORDS:

Coronary plaque; Eicosapentaenoic acid; Intravascular ultrasound; Residual risk

PMID:
28863874
DOI:
10.1016/j.jjcc.2017.07.007
[Indexed for MEDLINE]
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