Brinton Eliot A, Mason R Preston
Utah Foundation for Biomedical Research and the Utah Lipid Center, 419 Wakara Way, Suite 211, Salt Lake City, UT, 84108, USA.
Department of Medicine, Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA and Elucida Research LLC, PO Box 7100, Beverly, MA, 01915-6127, USA.
Lipids Health Dis. 2017 Jan 31;16(1):23. doi: 10.1186/s12944-017-0415-8.
The omega-3 fatty acid eicosapentaenoic acid (EPA) has multiple actions potentially conferring cardiovascular benefit, including lowering serum triglyceride (TG) and non-high-density lipoprotein cholesterol (non-HDL-C) levels and potentially reducing key steps in atherogenesis. Dietary supplements are a common source of omega-3 fatty acids in the US, but virtually all contain docosahexaenoic acid (DHA) in addition to EPA, and lipid effects differ between DHA and EPA. Contrary to popular belief, no over-the-counter omega-3 products are available in the US, only prescription products and dietary supplements. Among the US prescription omega-3 products, only one contains EPA exclusively (Vascepa); another closely related prescription omega-3 product also contains highly purified EPA, but is approved only in Japan and is provided in different capsule sizes. These high-purity EPA products do not raise low-density lipoprotein cholesterol (LDL-C) levels, even in patients with TG levels >500 mg/dL, in contrast to the increase in LDL-C levels with prescription omega-3 products that also contain DHA. The Japanese prescription EPA product was shown to significantly reduce major coronary events in hypercholesterolemic patients when added to statin therapy in the Japan EPA Lipid Intervention Study (JELIS). The effects of Vascepa on cardiovascular outcomes are being investigated in statin-treated patients with high TG levels in the Reduction of Cardiovascular Events With EPA-Intervention Trial (REDUCE-IT).
ω-3脂肪酸二十碳五烯酸（EPA）具有多种可能带来心血管益处的作用，包括降低血清甘油三酯（TG）和非高密度脂蛋白胆固醇（non-HDL-C）水平，并可能减少动脉粥样硬化形成的关键步骤。在美国，膳食补充剂是ω-3脂肪酸的常见来源，但实际上所有产品除了EPA外还含有二十二碳六烯酸（DHA），且DHA和EPA的脂质效应有所不同。与普遍看法相反，美国没有非处方ω-3产品，只有处方产品和膳食补充剂。在美国的处方ω-3产品中，只有一种仅含有EPA（Vascepa）；另一种密切相关的处方ω-3产品也含有高纯度EPA，但仅在日本获批，且有不同的胶囊规格。这些高纯度EPA产品不会升高低密度脂蛋白胆固醇（LDL-C）水平，即使是TG水平>500mg/dL的患者也是如此，这与同时含有DHA的处方ω-3产品会升高LDL-C水平形成对比。在日本EPA脂质干预研究（JELIS）中，日本的处方EPA产品在添加到他汀类药物治疗中时，被证明可显著降低高胆固醇血症患者的主要冠状动脉事件。在EPA干预降低心血管事件试验（REDUCE-IT）中，正在对他汀类药物治疗的高TG水平患者研究Vascepa对心血管结局的影响。
