二十碳五烯酸对接受他汀类药物治疗的冠心病患者心血管事件的增量影响。
Incremental effects of eicosapentaenoic acid on cardiovascular events in statin-treated patients with coronary artery disease.
作者信息
Matsuzaki Masunori, Yokoyama Mitsuhiro, Saito Yasushi, Origasa Hideki, Ishikawa Yuichi, Oikawa Shinichi, Sasaki Jun, Hishida Hitoshi, Itakura Hiroshige, Kita Toru, Kitabatake Akira, Nakaya Noriaki, Sakata Toshiie, Shimada Kazuyuki, Shirato Kunio, Matsuzawa Yuji
机构信息
Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Minamikogushi, Ube, Japan.
出版信息
Circ J. 2009 Jul;73(7):1283-90. doi: 10.1253/circj.cj-08-1197. Epub 2009 May 8.
BACKGROUND
Results from JELIS (Japan EPA Lipid Intervention Study) demonstrated the efficacy of pure eicosapentaenoic acid (EPA) in preventing coronary artery disease (CAD) in hypercholesterolemic patients under statin treatment. The present study examined in detail whether EPA is effective for the secondary prevention of CAD.
METHODS AND RESULTS
Patients with established CAD and a total cholesterol level > or =250 mg/dl were observed with a mean follow-up of 4.6 years. They were randomly assigned to receive either 1,800 mg of EPA + statin (EPA group) or statin alone (control group). The incidence of major coronary events (MCE) were compared in the 2 groups. The incidence of MCE was significantly lower in the EPA group (8.7% vs 10.7%, adjusted hazard ratio =0.77, 95% confidence interval (CI) 0.63-0.96, P=0.017, number needed to treat (NNT) =49). Among 1,050 patients with prior myocardial infarction (MI), the incidence of MCE in the EPA group (15.0%) was significantly lower than that in the control group (20.1%, adjusted hazard ratio =0.73, 95%CI 0.54-0.98, P=0.033, NNT =19).
CONCLUSIONS
EPA is effective for secondary prevention of CAD, especially in individuals with prior MI, and should be added to conventional treatment.
背景
日本 EPA 脂质干预研究（JELIS）的结果表明，在接受他汀类药物治疗的高胆固醇血症患者中，纯二十碳五烯酸（EPA）对预防冠状动脉疾病（CAD）有效。本研究详细探讨了 EPA 对 CAD 二级预防是否有效。
方法与结果
对确诊为 CAD 且总胆固醇水平≥250mg/dl 的患者进行观察，平均随访 4.6 年。他们被随机分配接受 1800mg EPA + 他汀类药物（EPA 组）或单独使用他汀类药物（对照组）。比较两组主要冠状动脉事件（MCE）的发生率。EPA 组 MCE 的发生率显著较低（8.7%对 10.7%，调整后风险比 = 0.77，95%置信区间（CI）0.63 - 0.96，P = 0.017，需治疗人数（NNT）= 49）。在 1050 例既往有心肌梗死（MI）的患者中，EPA 组 MCE 的发生率（15.0%）显著低于对照组（20.1%，调整后风险比 = 0.73，95%CI 0.54 - 0.98，P = 0.033，NNT = 19）。
结论
EPA 对 CAD 的二级预防有效，尤其是对既往有 MI 的个体，应添加到常规治疗中。
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