Shinagawa East One Medical Clinic, Tokyo, Japan.
J Atheroscler Thromb. 2011;18(2):99-107. doi: 10.5551/jat.5876. Epub 2010 Nov 17.
The Japan EPA Lipid Intervention Study (JELIS) was the first prospective randomized clinical trial to demonstrate prevention of coronary events by pure eicosapentaenoic acid (EPA). The aim of this study was to examine the relationships between various plasma fatty acid concentrations and the risk of coronary events in JELIS participants.
In 15,534 participants, we calculated the hazard ratio for major coronary events (sudden cardiac death, fatal or nonfatal myocardial infarction, unstable angina pectoris, and angioplasty/stenting or coronary artery bypass grafting) relative to the on-treatment average level of plasma fatty acids with the Cox proportional hazard model.
As a result of EPA intervention, the plasma EPA concentration increased, but the docosahexaenoic acid (DHA) concentration did not. The other fatty acids measured decreased slightly. The higher plasma level of EPA (hazard ratio=0.83, p=0.049, in all participants and hazard ratio=0.71, p=0.018, in the EPA intervention group), but not of DHA, was inversely associated with the risk of major coronary events. The associations between other fatty acids and the risk of major coronary events were not significant. In all JELIS participants, the risk of major coronary events was significantly decreased (20%) in the group with high (150 µg/mL or more) on-treatment plasma EPA concentration compared with that in the low (less than 87 µg/mL) group.
The risk of coronary artery disease is influenced by variations in plasma fatty acid composition. Among n-3 polyunsaturated fatty acids, EPA and DHA exhibited differences in the correlation with the risk of major coronary events.
日本 EPA 脂质干预研究（JELIS）是首个前瞻性随机临床试验，证明纯二十碳五烯酸（EPA）可预防冠心病事件。本研究旨在探讨 JELIS 参与者各种血浆脂肪酸浓度与冠心病事件风险之间的关系。
在 15534 名参与者中，我们使用 Cox 比例风险模型计算了相对于治疗期间平均血浆脂肪酸水平的主要冠心病事件（心源性猝死、致死性或非致死性心肌梗死、不稳定型心绞痛、经皮冠状动脉介入治疗或冠状动脉旁路移植术）的风险比。
由于 EPA 干预，血浆 EPA 浓度增加，但二十二碳六烯酸（DHA）浓度没有增加。测量的其他脂肪酸略有下降。较高的血浆 EPA 水平（风险比=0.83，p=0.049，所有参与者；风险比=0.71，p=0.018，EPA 干预组），而不是 DHA，与主要冠心病事件的风险呈负相关。其他脂肪酸与主要冠心病事件风险之间没有显著关联。在所有 JELIS 参与者中，与低（低于 87μg/ml）治疗组相比，高（150μg/ml 或以上）治疗组血浆 EPA 浓度的主要冠心病事件风险显著降低（20%）。
冠心病风险受血浆脂肪酸组成变化的影响。在 n-3 多不饱和脂肪酸中，EPA 和 DHA 与主要冠心病事件风险的相关性存在差异。
