Residual risk of cardiovascular events after treatment with stain might be explained in part because patients have low levels of n-3 polyunsaturated fatty acids (PUFA).
Several large trials and meta-analyses have consistently demonstrated that statin therapy significantly reduces LDL-C levels and incidence of cardiovascular events.
In spite of the efficacy of statin therapy in these studies, statins did not eliminate cardiovascular risk. Rather, significant residual cardiovascular risk remains after treatment with statins, especially in high-risk patients such as those with diabetes.
Now, Kurisu S and colleagues Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences has shown that the lipid-lowering therapy with strong statin reduced n-3 PUFAs in proportion to the decrease in the LDL cholesterol level in patients with coronary artery disease.
The study population consisted of 46 patients with coronary artery disease whose low-density lipoprotein (LDL) cholesterol was more than 100 mg/dl. Lipid-lowering therapy was performed with a strong statin including atorvastatin (n = 22), rosuvastatin (n = 9) or pitavastatin (n = 15). Serum PUFA levels were determined by gas chromatography. The treatment with strong statin decreased the sum of dihomo-γ-linolenic acid (DGLA) and arachidonic acid (AA) levels (195 ± 41 to 184 ± 44 μg/ml, P < 0.05) as well as the sum of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels (233 ± 71 to 200 ± 72 μg/ml, P < 0.001). These effects of strong statin resulted in a significant decrease in ratio of the sum of EPA and DHA levels to the sum of DGLA and AA levels (1.20 ± 0.27 to 1.10 ± 0.35, P < 0.05). The percent decrease in the LDL cholesterol level correlated significantly with that in the sum of EPA and DHA levels (r = 0.38, P < 0.01).
As athero-sclerosis has an important inflammatory component and n-3 PUFAs are potent anti-inflammatory agents, it is possible that such anti-inflammatory effects contribute towards their protection against cardiovascular disease.
Thus the combination of statins with n-3 PUFAs, popularly referred to as omega-3 fatty acids, may have potential value in in patients with coronary artery disease.
Talk to your doctor if you are already on statins.
Kurisu S, Ishibashi K, Kato Y, Mitsuba N, Dohi Y, Nishioka K, Kihara Y. Effects of lipid-lowering therapy with strong statin on serum polyunsaturated fatty acid levels in patients with coronary artery disease. Heart Vessels. 2011 Dec 21. [Epub ahead of print]