Switching from EPA + DHA (Omega-3-acid Ethyl Esters) to High-Purity EPA (Icosapent Ethyl) in a Statin-Treated Patient with Persistent Dyslipidemia and High Cardiovascular Risk: A Case Study

Abstract

Cardiovascular (CV) risk may remain despite statin treatment, and there is a need to address this risk with add-on therapy. The lipid effects of two different prescription omega-3 fatty acid therapies are described in a 55-year-old statin- and niacin-treated female with severe dyslipidemia and high CV risk. The patient was initially treated with omega-3-acid ethyl esters (eicosapentaenoic acid [EPA] and docosahexaenoic acid) 4 g/day. Due to persistently elevated low-density lipoprotein cholesterol (LDL-C), she was switched to icosapent ethyl (high-purity EPA ethyl ester) 4 g/day. Approximately 28 months after switching to icosapent ethyl, her LDL-C decreased by 69% to 52 mg/dL, triglycerides decreased by 35% to 119 mg/dL, non-high-density lipoprotein cholesterol (non-HDL-C) decreased by 63% to 76 mg/dL, total cholesterol decreased by 44% to 137 mg/dL, and HDL-C increased by 45% to 61 mg/dL. Total and small dense LDL particle concentrations decreased by 60 and 59%, respectively. Treatment was well tolerated, with improvements maintained over two years.

Small, dense LDL

“…Approximately, 28 months after switching to icosapent ethyl, LDL-C, triglycerides, non-HDL-C and TC decreased, whereas HDL-C increased. Importantly, total and sdLDL particle concentrations decreased by 60 and 59%, respectively [44].…”

“…Dietary supplementation with marine n-3 polyunsaturated FAs may have a beneficial effect on sdLDL particles, but had no effect on LDL density or sdLDL levels in patients with end-stage renal disease [43 & ]. On the other hand, the lipid effects of two different prescription omega-3 FA therapies [omega-3-acid ethyl esters (EPA and docosahexaenoic acid 4 g/day and then switched to icosapent ethyl (high-purity EPA ethyl ester) 4 g/day] are described as well tolerated in a 55-year-old statintreated and niacin-treated woman with severe dyslipidaemia and high cardiovascular risk, with improvements maintained over 2 years [44]. Approximately, 28 months after switching to icosapent ethyl, LDL-C, triglycerides, non-HDL-C and TC decreased, whereas HDL-C increased.…”