Omega-3 polyunsaturated fatty acids and coronary unstable plaque -Hint to further reduce coronary events

摘要

Dyslipidemia is a powerful predictor of coronary artery disease (CAD) in patients with metabolic syndrome, type 2 diabetes, and previous history of CAD. Lowering low-density lipoprotein cholesterol (LDL-C) level with statins is established as the primary strategy for reducing cardiovascular risk, but clinical trials have consistently shown a residual risk of CAD remains with statin treatment. Therefore, other lipid-modifying strategies that can deal with this limitation of statins are required. Epidemiologic studies have shown that a higher dietary intake of fish is associated with lower incidence of cardiovascular events. Two major randomized control trials documented the beneficial effect of omega-3 polyunsaturated fatty acids (PUFA) supplementation on cardiovascular events. The GISSI-Prevenzione study showed that taking 850 mg of eicosapentaenoic acid (EPA) and doco-sahexaenoic acid (DHA) was associated with 21% and 30% reductions in total mortality and cardiovascular mortality, respectively, in patients with myocardial infarction.4 In JELIS, patients with hypercholesterolemia were randomized to a statin alone group and a statin plus 1,800mg/day EPA group, and the EPA+statin group had a 19% reduction in coronary events compared with the statin alone group. In a recent evaluation of data from 97 randomized, placebo-controlled trials of different lipid-lowering interventions, the most favorable effects of treatment compared with controls were observed with statins and omega-3 PUFA. Reduction of cardiac mortality was greater for omega-3 PUFA than for statins (32% vs. 23%). Attention has now moved to the benefits of omega-3 PUFA for protection against cardiovascular events.