Hassan Amir, Tajuddin Nadeem, Shaikh Ali
SE Memorial Clinic, 11914 Astoria Blvd, Suite 330, Houston, TX, 77089, USA,
Cardiol Ther. 2015 Jun;4(1):83-93. doi: 10.1007/s40119-014-0032-9. Epub 2014 Dec 17.
Patients with diabetes and prediabetes are at increased risk of dyslipidemia and cardiovascular disease. To reduce this risk, statins and additional therapies may be considered. Omega-3 fatty acids offer an option to reduce triglycerides (TG) and potentially improve other lipid parameters, although products that contain docosahexaenoic acid (DHA) may increase low-density lipoprotein cholesterol (LDL-C) while eicosapentaenoic acid (EPA) does not. Prescription formulations include omega-3-acid mixtures (combination of predominantly EPA and DHA), and icosapent ethyl (high-purity prescription form of EPA ethyl ester); prescription omega-3 products are indicated as an adjunct to diet to reduce TGs in adult patients with severe hypertriglyceridemia at a dose of 4 g/day.
This was a retrospective analysis of records from a private endocrinology practice of patients who received omega-3-acid ethyl esters (OM3EE) (4 g/day) and were subsequently switched to icosapent ethyl (IPE; 4 g/day) due to the potential of OM3EE to raise LDL-C and/or cause gastrointestinal upset. Patient records were analyzed for LDL-C, TG, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and non-HDL-C measured before and after the switch to IPE.
The records of ten patients met the criteria for this analysis and were included. All patients had taken OM3EE for ≥1 year prior to their last lipid measurement before switching to IPE, and all had been taking IPE for >3 months at the time of their subsequent lipid measurement. Nine of the ten patients were on concomitant statin therapy throughout. Reductions in LDL-C, TC, and non-HDL-C were observed in eight patients, reductions or no changes in TG were observed in eight patients, and increases or no changes in HDL-C were observed in eight patients. No gastrointestinal adverse events were observed.
In most patients with prediabetes or diabetes who switched from OM3EE to IPE, LDL-C and other lipid parameters improved. IPE was well tolerated.
糖尿病和糖尿病前期患者发生血脂异常和心血管疾病的风险增加。为降低这种风险，可考虑使用他汀类药物及其他疗法。ω-3脂肪酸是降低甘油三酯（TG）并可能改善其他血脂参数的一种选择，不过，含有二十二碳六烯酸（DHA）的产品可能会升高低密度脂蛋白胆固醇（LDL-C），而二十碳五烯酸（EPA）则不会。处方制剂包括ω-3酸混合物（主要是EPA和DHA的组合）以及二十碳五烯酸乙酯（EPA乙酯的高纯度处方形式）；处方ω-3产品被指定作为饮食的辅助手段，用于降低严重高甘油三酯血症成年患者的TG，剂量为4克/天。
这是一项对一家私人内分泌诊所记录的回顾性分析，这些患者接受了ω-3酸乙酯（OM3EE）（4克/天）治疗，随后因OM3EE有升高LDL-C和/或引起胃肠道不适的可能性而改用二十碳五烯酸乙酯（IPE；4克/天）。分析患者记录中改用IPE前后测量的LDL-C、TG、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）和非HDL-C。
十名患者的记录符合该分析标准并被纳入。所有患者在改用IPE之前的最后一次血脂测量前服用OM3EE≥1年，并且在随后的血脂测量时所有患者服用IPE均超过3个月。十名患者中有九名在整个过程中同时接受他汀类药物治疗。八名患者的LDL-C、TC和非HDL-C有所降低，八名患者的TG有所降低或无变化，八名患者的HDL-C有所升高或无变化。未观察到胃肠道不良事件。
在大多数从OM3EE改用IPE的糖尿病前期或糖尿病患者中，LDL-C和其他血脂参数得到改善。IPE耐受性良好。
