Relationship between Coronary Artery Disease and Non-HDL-C, and Effect of Highly Purified EPA on the Risk of Coronary Artery Disease in Hypercholesterolemic Patients Treated with Statins: Sub-Analysis of the Japan EPA Lipid Intervention Study (JELIS)

Abstract

Aim:The present study examined the importance of reducing non-high-density lipoprotein cholesterol (non-HDL-C) for the primary prevention of the occurrence of coronary artery disease (CAD) in the JELIS, and the effects of EPA. Methods: The patients were distributed into 4 subgroups using the lipid management goal for LDL-C recommended by the Japan Atherosclerosis Society guideline (2007) and the goal for non-HDL-C defined as 30 mg/dL higher than LDL-C: A) achieved both goals; B) achieved the LDL-C but not non-HDL-C goal; C) achieved the non-HDL-C but not LDL-C goal; and D) did not attain either goal. The incidences of CAD in the 4 subgroups were compared, and the effects of eicosapentaenoic acid (EPA) on the risk of CAD in these subgroups were examined. Results: In the non-EPA group, the incidence of CAD in patients who did not achieve the goals for LDL-C or non-HDL-C was higher than in patients who achieved those goals. Patients in subgroups B, C, and D were at higher risk for CAD than those in subgroup A (B, HR 2.31; C, HR 1.90; D, HR 2.47). EPA reduced the risk of CAD by 38% in subgroups B, C, and D (p= 0.007). Conclusion:We reconfirmed non-HDL-C as a predictor of the risk for CAD and a residual risk marker of CAD after LDL-C-lowering therapy. EPA was useful to reduce the occurrence of CAD in patients who did not achieve the goals for LDL-C and/or non-HDL-C.

National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 1—Full Report

“…216 Several nonstatins also have RCT evidence for ASCVD reduction as statin adjuncts in subgroup analyses of patients with elevated triglycerides or elevated triglycerides plus low HDL-C concentrations. 198 These include eicosapentaenoic acid ethyl esters, 313,326 fibrates (Fig. 14), 314,327 and niacin.…”

Diagnostic Criteria for Dyslipidemia

“…non HDL-C level of ≥ 190 mg/dL. In a subanalysis of the JELIS that compared the groups that achieved both LDL-C and non HDL-C management goals, the other groups exhibited higher incidences of CAD 53) . Recently, it was demonstrated that the non HDL-C level in Japanese individuals is equal to LDL-C ＋30 mg/dL, the same as that observed in the U.S 54,55) .…”

Effects of Fenofibric Acid on Carotid Intima-Media Thickness in Patients With Mixed Dyslipidemia on Atorvastatin Therapy

“…These results are consistent with those from the 5 other cardiovascular outcome trials that evaluated the benefits of a triglyceride-lowering therapy in the subgroup of patients with significant hypertriglyceridemia. [6][7][8][9][10] The measurement of carotid intima-media thickness (cIMT) is a well-validated surrogate end point for evaluating the impact of a therapy on cardiovascular risk. 11,12 cIMT has been shown to correlate with risk of future cardiovascular events, 11,12 and changes in cIMT over time have been used extensively to evaluate the potential clinical efficacy of antiatherosclerotic agents.…”