Relationship between coronary artery disease and non-HDL-C,and effect of highly purified EPA on the risk of coronary artery disease in hypercholesterolemic patients treated with statins: Sub-analysis of the Japan EPA lipid intervention study (JELIS)

Aim: the present study examined the importance of reducing non-high-density lipoprotein cholesterol (non-hdl-c) for the primary prevention of the occurrence of coronary artery disease (cad) in the jelis,and the effects of epa. methods: the patients were distributed into 4 subgroups using the lipid management goal for ldl-c recommended by the japan atherosclerosis society guideline (2007) and the goal for non-hdl-c defined as 30 mg/dl higher than ldl-c: a) achieved both goals; b) achieved the ldl-c but not non-hdl-c goal; c) achieved the non-hdl-c but not ldl-c goal; and d) did not attain either goal. the incidences of cad in the 4 subgroups were compared,and the effects of eicosapentaenoic acid (epa) on the risk of cad in these subgroups were examined. results: in the non-epa group,the incidence of cad in patients who did not achieve the goals for ldl-c or non-hdl-c was higher than in patients who achieved those goals. patients in subgroups b,c,and d were at higher risk for cad than those in subgroup a (b,hr 2.31; c,hr 1.90; d,hr 2.47). epa reduced the risk of cad by 38% in subgroups b,c,and d (p= 0.007). conclusion: we reconfirmed non-hdl-c as a predictor of the risk for cad and a residual risk marker of cad after ldl-c-lowering therapy. epa was useful to reduce the occurrence of cad in patients who did not achieve the goals for ldl-c and/or non-hdl-c.