www.CHESTERCMS.org FISH OIL: Use or Not continued from page 13 End Point Group A (Icosapentethyl +statin) Group B (placebo + statin) P value Cardiovascular death or non-fatal myocardial infarction 392 (9.6%) 507 (12.4%) <0.001 Fatal or non-fatal myocardial infarction 250 (6.1%) 355 (8.7%) <0.001 Urgent or emergency re-vascularization 216 (5.3%) 321 (7.8%) <0.001 Cardiovascular death 174 (4.3%) 213 (5.2%) 0.03 Hospitalization for unstable angina 108 (2.6%) 157 (3.8%) 0.002 Fatal or non-fatal stroke 98 (2.4%) 134 (3.3%) 0.01 Death from any cause, non-fatal 549 (13.4%) myocardial infarction, or non-fatal stroke 690 (16.9%) <0.001 Death from any cause 310 (7.6%) - 274 (6.7%) Table 1 statin therapy alone (no placebo) - found that there was a 19% reduction in major coronary events in the EPA plus statins group versus statins alone. These two powerful studies have shed light on the importance of treating hypertriglyceredemia as a means to prevent cardiovascular events. Table 1: For each cardiovascular endpoint Group A had a statistically significant lesser number of recorded events. Placebo was statistically inferior to taking icosapentethyl with statins. Ultimately the conclusion of this breakthrough study was that use of icosapentethyl at a dose of 2 grams twice per day significantly lowered the risk of ischemic events and cardiovascular death versus placebo. Another similar study conducted in Japan, the JELIS study, analyzed the use of eicosapentaeonic acid (EPA) in combination with statins versus 14 CHESTER COUNT Y Medicine | WINTER 2020 At the end of 2019 the FDA updated its guidelines to include icosapentethyl (Vascepa). Currently, the recommendation states that patients with triglycerides above 150 mL/dL on maximally tolerated statin therapy should also take icosapentethyl as adjunctive therapy to reduce their risk of cardiovascular events. The new FDA guidelines show the promise of continued use of purified omega-3's in cardiology practice, and has showed the scientific community that despite previous research on the gray area of the role omega-3 fatty acids in regulating cardiovascular health that use of high intensity omega-3 can have significant benefits. An important part of this study was that benefits were not just because of drop in triglycerides but even when triglycerides were in normal range benefits were seen.http://www.chestercms.org