Fish Oil Supplementation Reduces Nonfatal Cardiac Events in Japan

However, this effect may be seen only in countries where average levels of fish consumption are very high.

Eicosapentaenoic acid (EPA), a long-chain n-3 polyunsaturated fatty acid found in fish oil, is approved in Japan for treatment of hyperlipidemia and peripheral artery disease, and in Europe for reduction of mortality after myocardial infarction. But fish oil components have not been tested for primary prevention of heart disease in a high-risk population.

In this randomized study from Japan, 18,645 patients (mean age, 61) with total cholesterol levels of at least 251 mg/dL received a low-dose statin plus EPA (600 mg, 3 times daily) or a statin alone. Eighty percent of them had no history of cardiovascular disease, and none had had an acute cardiovascular event in the previous 6 months.

After an average 4.6 years of observation, significantly fewer patients taking EPA (2.8% vs. 3.5%) reached the primary composite endpoint of cardiac death, fatal or nonfatal MI, unstable angina, or coronary revascularization. The EPA group had significantly fewer episodes of unstable angina and combined nonfatal events, but not of fatal cardiac events.

Comment: Average fish intake is much higher in Japan than in most other countries, and fish oil may affect cardiac risk through a variety of mechanisms. Mortality benefits seen with low doses of fish oil in earlier European studies might not have been evident in this Japanese population with high fish intake and low baseline risk for coronary death. Moreover, the reduction in nonfatal events seen here may occur only at very high levels of fish oil intake. Therefore, these results should not be generalized to other settings.

— Bruce Soloway, MD

Published in Journal Watch General Medicine April 17, 2007

Citation(s):

Yokoyama M et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): A randomised open-label, blinded endpoint analysis. Lancet 2007 Mar 31; 369:1090-8.

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