高コレステロール血症患者の脳卒中発症に対するEPAの効果 ―JELISサブ解析

抄録

The JELIS (Japan EPA Lipid Intervention Study) was conducted with a PROBE design to examine the preventive effects of eicosapentaenoic acid (EPA) on coronary heart diseases (CHD) and other vascular events including stroke. In JELIS, patients with a total cholesterol of 250mg/dL or greater were recruited throughout Japan between 1996 and 1999. Patients were randomly assigned to receive 1,800mg of EPA daily with statin (EPA group; n=9,326) or statin only (control group; n=9,319) with a 5-year follow-up. One of the major findings was a significant suppression of CHD by 19% in the EPA group as compared to the control group. There were no statistically significant differences between the two groups in total stroke incidence. In patients with the past history of stroke, stroke recurrence was detected in 6.8% of patients in the EPA group as compared with 10.5% of patients in the control group, indicating a significant 20% relative reduction of stroke recurrence by EPA (p=0.047). The mean EPA concentrations on treatment in all patients were divided in tertile. Incidence of stroke was significantly lower in the highest tertile by 14% than in the lowest tertile (p=0.042). When only the patients with good compliance for test drug were selected for analysis, these patients in the EPA group showed a significantly lower incidence of stroke by 14% than those in the control group (p=0.048). The patients with the past history of stroke and good compliance for test drug showed a significantly lower incidence of stroke recurrence in the EPA group by 36% than in the control group (p=0.004). These data indicate that EPA is a promising treatment for prevention of stroke, especially for the secondary prevention of ischemic stroke in Japanese hypercholesterolemic patients.