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Background: In the Japan Eicosapentaenoic Acid (EPA) Lipid Intervention Study (JELIS) a low plasma EPA (<150 ug/mL) and a low EPA to arachidonic acid (EPA/AA) ratio (<0.75) were associated with increased major coronary events. In Japan, it has been proposed that patients who are either classified as high risk for cardiovascular disease (secondary prevention with >3 risk factors, polyvascular disease or recurrence) or as moderate risk (secondary prevention or primary prevention with >3 risk factors) and with an EPA/AA ratio of <0.4 are candidates for EPA treatment. It is currently unknown what the plasma EPA levels and the EPA/AA ratios are in high cardiovascular risk individuals in the United States with an LDL-C >190 mg/dL, one of the key thresholds established for patient groups who may be considered for treatment in the AHA/ACC Guidelines. The purpose of this study was to determine the prevalence of plasma EPA <150 ug/mL, EPA/AA ratio <0.75, and an EPA/AA ratio <0.40 in high risk individuals with an LDL-C > 190 mg/dL.
Methods: EPA and AA were measured using the Boston Heart Diagnostics Fatty Acid Balance™ Test and the EPA/AA ratio was then calculated. The study group was comprised of 8,010 baseline patient samples with an LDL-C >190 mg/dL. The baseline lipid panel levels and prevalence of plasma EPA, AA levels and the EPA/AA ratios were evaluated.
Results: The median EPA value was 30.2 ug/mL, and 97.5% of the patients had a plasma EPA less than the cutoff of 150 ug/mL established by the JELIS trial. The EPA/AA ratio showed similarly low levels. The median EPA/AA ratio value was 0.08, and 99.2% of the patients had a plasma EPA/AA ratio less than the cutoff of 0.75 established by the JELIS trial. Additionally, 96.2% of the patients had a plasma EPA/AA lower than the threshold of 0.40, which suggests they should receive EPA supplementation.
Conclusions: This patient population with severely elevated LDL-C showed alarmingly low levels of both plasma EPA and EPA/AA ratios. Applying previously reported cutoffs demonstrated that greater than 96% of patients had insufficient EPA and were at increased risk for cardiovascular events based on these criteria.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Advances in Cholesterol Measurement and Management
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1106-056
- 2017 American College of Cardiology Foundation