Abstract 1348: Effects of EPA on Coronary Artery Disease in Hypercholesterolemic Patients with Multiple-Risk-Factors: Sub-Analysis of Primary Prevention Cases from JELIS
Introduction: The Japan EPA Lipid Intervention Study (JELIS) employed a PROBE design to examine the effects of EPA on coronary events in hypercholesterolemic patients. In this follow-up study, we analyzed the relationship between multiple-risk-factors and coronary artery disease (CAD) incidence, and the effects of EPA on primary prevention of CAD.
Methods: Total cholesterol level of each patient was more than 250mg/dl at baseline. The primary subgroup of 14,981 patients was randomly assigned to statin only (n=7,478) or EPA with statin (n=7,503). Endpoint was major coronary events (MCE: sudden cardiac death, fatal and nonfatal myocardial infarction, unstable angina, pectoris including hospitalization for ischemic episodes, and events of angioplasty/stenting or coronary artery bypass grafting). We chose the risk factors, Hypercholesterolemia; Diabetes; BMI; Hypertension; High TG or low HDL-C; to analyze the relationship between multiple-risk-factors and CAD.
Results: MCE incidence was higher in patients with diabetes (HR, hazard ratio: 2.10, P<0.0001), hypertension (HR: 1.85, P<0.0001) , or smoking (HR: 1.45, P=0.034). MCE occurrence was especially elevated in patients with TG level ≥150mg/dl and HDL-C <40mg/dl at registration (HR: 1.71, P=0.014). Analysis of multiple-risk-factors showed MCE increased by an average 31% with each increase in total factor number (HR: 1.31, P<0.0001, 95%Cl: 1.16–1.48). EPA treatment resulted in similar considerable MCE reduction for patients with 1 or 2 risk factors (HR: 0.81) and those with 3 to 5 risk factors (HR: 0.81) while patients with high TG/low HDL-C levels showed significant reductions (HR: 0.47, p=0.043).
Conclusion: MCE significantly increased for patients with diabetes, hypertension, or smoking while those with elevated TG/low HDL-C levels were especially high risk. Multiple-risk-factor analysis showed MCE increased with every increase in the total number of risk factors. EPA was equally effective in reducing MCE regardless of the number of risk factors patients possessed and was especially effective in high TG/low HDL-C patients. Therefore EPA would be effective in preventing MCE across a broad spectrum of CAD risk factors.