Abstract 17785: Eicosapentaenoic Acid Add-on to Atorvastatin Normalizes Pre-β1-HDL Levels
Background: Although eicosapentaenoic Acid (EPA) add-on to statins reduced 20% risk in major coronary events compared with statin-alone in JELIS study, in spite of minimal changes in plasma lipid levels, few data exist regarding mechanism of add-on effects of EPA to statin in lipoprotein profiles. Therefore, we investigated the add-on effects of EPA to atorvastatin in clinical patients.
Methods: Seventeen patients with primary hyperlipidemia (7 males, mean age of 66 ± 12) were enrolled. Fasting lipid profiles were evaluated at baseline, 8 weeks treatment with 10mg atorvastatin, and further 8 weeks treatment with 10mg atorvastatin plus 1800mg EPA. HPLC analysis of lipoproteins enabled comparison in 20 subfractions. LDL was fractionated into 6 (LDL8∼13), and HDL was fractionated into 7 (HDL14∼20). Small pre-β1-HDL levels were determined with ELISA. Plasma hsCRP, SAA and PTX3 were measured as inflammatory marker. Also 24 fractions of fatty acids were determined.
Results: Atorvastatin decreased LDL-C -43% from baseline, but EPA add-on did not show any apparent changes in LDL-C, TG, and HDL-C. In HPLC analysis, atorvastatin reduced all LDL subfractions, but EPA add-on significantly decreased -7∼10% only in small∼very-small LDL-C (LDL10-13). In HDL, atorvastatin significantly increased +6% in medium HDL-C (HDL17), and decreased -10% in very-small HDL-C (HDL20). EPA add-on significantly decreased -8% in very-small HDL-C (HDL20) in addition to statin. Baseline pre-β1-HDL was high (26.8 ± 5.9 μg/mL) as previously reported in coronary high risk patients, and was almost same with atorvastatin (27.6 ± 14μg/mL), but significantly reduced with EPA add-on (23.7 ± 14μg/mL, p<0.05). In fatty acid components, EPA add-on increased EPA itself (+87%). Atorvastatin significantly decreased -11% in arachidonic acid, and EPA add-on decreased -17% further. No changes were observed in inflammatory markers in this study.
Conclusion: EPA add-on to atorvastatin decreased pre-β1-HDL levels, very-small HDL-C, and small∼very-small LDL-C. EPA add-on showed significant favorable changes in important lipoprotein subfraction associated with pro- or anti-atherogenesis, although EPA add-on did not show significant differences in gross HDL-C or LDL-C.
- © 2010 by American Heart Association, Inc.