在他汀类药物治疗的稳定型冠状动脉疾病患者中，给予二十碳五烯酸可能会改变高密度脂蛋白的异质性：一项为期 6 个月的随机试验。

Administration of eicosapentaenoic acid may alter high-density lipoprotein heterogeneity in statin-treated patients with stable coronary artery disease: A 6-month randomized trial.

机构信息

Department of Health Planning Center and Cardiology, Nihon University Hospital, Tokyo Japan.

Department of Cardiology, Nihon University Hospital, Tokyo Japan.

出版信息

J Cardiol. 2020 Mar;75(3):282-288. doi: 10.1016/j.jjcc.2019.08.011. Epub 2019 Sep 20.

DOI:10.1016/j.jjcc.2019.08.011

PMID:31543378

Abstract

BACKGROUND

Combined statin plus eicosapentaenoic acid (EPA) therapy might be a potentially effective treatment option to prevent coronary artery disease (CAD). The serum EPA/arachidonic acid (AA) ratio has been identified as a potential new risk marker for CAD. Few data exist whether administration of EPA could affect high-density lipoprotein (HDL) particle size. We hypothesized that the addition of EPA to ongoing statin therapy may result in altered HDL heterogeneity.

METHODS

We conducted this 6-month, single-center, prospective, randomized open-label clinical trial to investigate the effect of the additional administration of EPA on the HDL heterogeneity (HDL, HDL and HDL/HDL ratio) in stable CAD patients receiving treatment with statins. We assigned stable CAD patients already receiving statin therapy to the EPA group (1800mg/day: n=50) or the control group (n=50).

RESULTS

A significant decrease in the serum HDL level (-4.7% vs. -0.5%, p=0.037), but not of the serum HDL level, and a significant increase in the HDL/HDL ratio (5.5% vs. -5.1%, p=0.032) were observed in the EPA group as compared to the control group. Multiple regression analysis with adjustments for coronary risk factors identified the achieved EPA/ AA ratio as an independent and significant predictor of an increase of the HDL/HDL ratio (β=0.295, p=0.001). Furthermore, the change in the serum cholesterol ester transfer protein mass was positively correlated with the change in the EPA/AA ratio in the EPA group (r=0.286, p=0.044), but not in the control group (r=0.121, p=0.401).

CONCLUSION

Administration of EPA might decrease the serum HDL level, resulting in an increase in the HDL/HDL ratio. Furthermore, increased EPA/AA ratio by the addition of EPA to ongoing statin therapy might be an indicator of an increase in the HDL/HDL ratio, thereby regulating HDL particle size.

CLINICAL TRIAL REGISTRATION

UMIN (http://www.umin.ac.jp/) Study ID: UMIN000010452.

摘要

背景

联合他汀类药物和二十碳五烯酸（EPA）治疗可能是预防冠状动脉疾病（CAD）的一种潜在有效治疗选择。血清 EPA/花生四烯酸（AA）比值已被确定为 CAD 的一个潜在新风险标志物。目前尚不清楚 EPA 的给药是否会影响高密度脂蛋白（HDL）颗粒大小。我们假设，在正在进行的他汀类药物治疗中添加 EPA 可能会导致 HDL 异质性发生变化。

方法

我们进行了这项为期 6 个月的、单中心、前瞻性、随机、开放标签临床试验，以研究在接受他汀类药物治疗的稳定型 CAD 患者中，额外给予 EPA 对 HDL 异质性（HDL、HDL 和 HDL/HDL 比值）的影响。我们将已经接受他汀类药物治疗的稳定型 CAD 患者分为 EPA 组（1800mg/天：n=50）或对照组（n=50）。

结果

与对照组相比，EPA 组血清 HDL 水平显著下降（-4.7%对-0.5%，p=0.037），但血清 HDL 水平没有变化，HDL/HDL 比值显著升高（5.5%对-5.1%，p=0.032）。经过对冠状动脉风险因素的调整，多元回归分析确定达到的 EPA/AA 比值是 HDL/HDL 比值升高的独立且显著的预测因子（β=0.295，p=0.001）。此外，EPA 组胆固醇酯转移蛋白质量的变化与 EPA/AA 比值的变化呈正相关（r=0.286，p=0.044），但在对照组中则无相关性（r=0.121，p=0.401）。