Researchers Yoshiaki Shintani & Tomohiro Kawasaki from the Shin-Koga Hospital, Kurume, Japan looked at the results from the JELIS study where both arms saw similar reductions in LDL-C yet the EPA supplemented (1.8g/day) arm saw a reduction in cardiovascular events. They wanted to explore these findings to see what else (besides LDL-C lowering) may play a factor in EPA's therapeutic benefit.
Their findings were published in the Journal of the American College of Cardiology 2012;59(13s1):E1731-E1731. Can be found here: content.onlinejacc.org/article.aspx
Their poster presentation is found here: www.google.com/url
Here is their methodology,
"A total of 51 lesions in 43 patients with suspected CAD (<75% stenosed vessels) and a LDL-C level of <160mg/dL were enrolled. The patients were randomly assigned to receive EPA or ezetimibe. Blood samples were collected to measure serum lipids and changes in coronary plaques were evaluated by MDCT at baseline and at a 1-year follow-up."
So, we have 1 year of treatment with EPA or Zetia (Ezetimibe). For reference, Zetia is approved for "the reduction of elevated TOTAL-C, LDL-C, Apo B, and non-HDL-C", www.zetia.com/ezetimibe/zetia/hcp/
This study simply looked at LDL-C numbers and the effects of EPA on coronary plaque stabilization compared to Zetia's performance in the same regard.
Here is what they found after 1 year:
The LDL-C did decrease in each group, however it was not stat significant in the EPA arm whereas the Zetia arm was stat significant. Almost predictably, the EPA/AA was drastically increased in the EPA treated patients compared to the Zetia arm. The EPA/AA ratio is seen as the balance or regulation between Anti-Inflammation and Inflammation in our body's immune response.
Now look at the change in the Vessel area, Lumen area and Plaque area... The Lumen is the channel through which our blood flows, the greater the diameter of our Lumen, the easier it is for our blood to travel through our vasculature. The Plaque area correlates to the thickening of our arterial walls.
EPA increased the size of the Lumen in treated patients by 8% whereas Zetia decreased the Lumen size by 16%, i.e. the channel narrowed. In line with those numbers, the Plaque area decreased in the EPA arm by 3.5% whereas it increased by 19.5% in the Zetia arm.
The Soft Plaque volume, shown by the HU results, also improved more greatly in patients treated with EPA...
This would suggest that 1 year duration is not enough to see the necessary improvement in Lumen area and Plaque reduction even if you reduce LDL-C. EPA seems to work independently of LDL-C where it is able to show improvement in patient's cardiovascular system as the final data point shows:
"The incidence of major cardiovascular events were lower in the EPA group than in the ezetimibe group (9.5% vs. 36.4%, p=0.03 by log-rank test)."
It seems that LDL-C is not the end all be all answer for those in need of cardiovascular therapy.
Disclosure: I am long AMRN.