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Is the ratio of Eicosapentaenoic Acid (EPA) to Arachidonic Acid a Residual Risk Marker?

Omega-3 polyunsaturated fatty acids (PUFAs) represent one therapeutic option for managing lipid-related residual cardiovascular risk. These treatments have a number of beneficial effects beyond their triglyceride-lowering action, including inhibition of platelet aggregation, anti-inflammatory effects, improvement in vascular endothelium function, and anti-hypertensive action. However, given conflicting clinical trial results, it may be that PUFAs levels need to exceed a threshold for anti-arteriosclerotic efficacy, which may depend on the EPA/arachidonic acid (AA) ratio at baseline (pre-treatment). This hypothesis was tested in a prospective, randomised clinical trial to investigate the effect of the additional administration of EPA (1800 mg/day, n=50) versus control (n=50) on the EPA/AA ratio in statin-treated stable coronary artery disease patients.
At 6 months, the achieved EPA/AA ratio was more reliable as an independent and significant predictor of reduction in non-high-density lipoprotein cholesterol (non-HDL-C), a measure of total atherogenic lipoproteins cholesterol load, than the absolute change in the EPA/AA ratio. There were also significant negative correlations between the baseline level and absolute change in non-HDL-C and triglyceride-rich lipoproteins. The authors concluded that the achieved EPA/AA ratio could be useful in risk stratification in statin-treated patients with a high non-HDL-C level.
The ratio of Eicosapentaenoic Acid (EPA) to Arachidonic Acid may be a residual risk marker in stable coronary artery disease patients receiving treatment with statin following EPA therapy.

Tani S, Nagao K, Kawauchi K et al.