Are All Fish Equally Close to the Heart?–2

Abstract

To the Editor: Lee et al provide a nice review of the cardiovascular benefit of omega-3 fatty acids. I question their claim that the Japan EPA Lipid Intervention Study (JELIS)1Yokoyama M Origasa H Matsuzaki M Japan EPA Lipid Intervention Study (JELIS) Investigators et al.Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis.Lancet. 2007; 369: 1090-1098Abstract Full Text Full Text PDF PubMed Scopus (1936) Google Scholar and Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico (GISSI-Prevenzione)2GISSI-Prevenzione Investigators Dietary supplementation with n-3 poly-unsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial.Lancet. 1999; 354: 447-455Abstract Full Text Full Text PDF PubMed Scopus (3729) Google Scholar trial demonstrate a lower cardiovascular risk despite “aggressive” therapy with standard pharmacotherapy. In the JELIS trial, the maximum dose of statin allowed was 10 mg of pravastatin, resulting in a reported 25% reduction in low-density lipoprotein cholesterol (LDL-C) from the baseline value of 183 mg/dL (to convert to mmol/L, multiply by 0.0259). This cannot be considered aggressive statin therapy considering the current recommendations from the American College of Cardiology and American Heart Association3Anderson JL Adams CD Antman EM et al.ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction).J Am Coll Cardiol. 2007; 50: e1-e157Abstract Full Text Full Text PDF PubMed Scopus (1572) Google Scholar of a target LDL-C of 70 mg/dL in patients with prior myocardial infarction. It remains unknown whether the 19% relative risk reduction in cardiovascular events associated with omega-3 fatty acids, driven primarily by the secondary outcome arm, would have been maintained in the context of aggressive statin use. Similarly, in the GISSI-Prevenzione trial, which enrolled patients who had had myocardial infarctions, only 46% of patients were receiving cholesterol-lowering drugs at 46 months, despite LDL-C levels of 137 mg/dL at baseline. Further research is necessary to determine whether omega-3 fatty acids provide cardiovascular benefit when cholesterol treatment follows the current guidelines. Are All Fish Equally Close to the Heart?–1Mayo Clinic ProceedingsVol. 83Issue 6PreviewTo the Editor: I read with great interest the recent article by Lee et al1 on the cardioprotective effect of omega-3 fatty acids. Supported by data from multiple clinical trials, the authors emphasized the beneficial effects of a mixture of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) on cardiovascular outcomes and all-cause mortality. I was particularly impressed by the growing body of evidence showing the synergistic effect of fish oil and statins on lowering triglycerides. Full-Text PDF