The additional effect of Eicosapentanoic acid on coronary plaque stability in stable angina patients with statin use by Optical Coherence Tomography analysis

Abstract

Purpose: Statin treatment is demonstrated to reduce cardiovascular events. However, even intensive statin treatment remains residual coronary risk. Eicosapentanoic Acid (EPA)has promising benefits for second prevention. The aim of this study is to access the additional effect of EPA on coronary plaque stability in patients with statin use by using Optical Coherence Tomography (OCT). Methods: Consecutive 14 patients who had received statin treatment before the past 6 month at baseline study with lipid-rich plaques on non-culprit lesion by OCT analysis were enrolled in this study. Of these,9 patients (10 lesions) received with EPA 1800mg/day after baseline study and 5 patients (5 lesions) with control group were assigned randomly. We measured thinnest Fibrous Cap Thickness (FCT) and the arc of lipid plaque at baseline and 9 month follow-up. Results: The change of Serum Eicosapentanoic Acid/Arachidonic acid (EPA/AA) ratio were 0.31±1.08 at baseline, 1.08±0.38 at 9 month in EPA group (p=0.0001) and 0.24±0.13, 0.26±0.16 in control group (p=0.63) respectively. Patients with both of groups had significantly thick FCT (140±48.3μm, 246±80.4μm, p=0.0004 in EPA group and 152±26.8μm, 178±19.2μm, p= 0.04, in control group), however the difference in the change of FCT was highly significant in EPA group (106±19.2μm vs. 26±9.2μm, p=0.0003).The change of the arc of lipid plaque also reduced significantly in EPA group compared to control group (-40.0±11.5° vs. -4.0±5.48°, p=0.0074). Table 1. Serum EPA/AA and OCT analysis Conclusion: Additional EPA treatment was effective on coronary plaque stabilization with increasing fibrous cap thickness and decreasing the arc of lipid plaque.