Abstract
It is well recognized that statin has a possibility of plaque stabilization in coronary and carotid arteries, however,
cardiac and cerebral adverse events might occur even in the patients undergoing aggressive statin therapy. Although
n-3 polyunsaturated fatty acid (PUFA) such as EPA is reported to be able to reduce the risk of ischemic coronary artery
disease, it remains unclear about the effect of n-3 PUFA on the carotid artery disease. In the current study, we analyzed
the correlation of atherosclerosis-related factors and plaque vulnerability based on MRI black blood technique
in carotid artery stenotic patients with normal LDL-C. As a result, most of the patients with carotid vulnerable plaque
had a low blood ratio of eicosapentaenoic acid to arachidonic acid (EPA/AA ratio) of less than 0.4, and predominantly
intraplaque hemorrhage in the affected carotid artery. Moreover, oral uptake of EPA 1,800 mg/day for 45 days (median)
was able to stabilize specifically intraplaque hemorrhage through the upregulation of the EPA/AA ratio. Taken
into consideration that our previous study demonstrated the combined oral administration of EPA and rosuvastatin
leads to a beneficial effect on plaque composition of both intraplaque hemorrhage and lipid-rich necrotic core (Surg
Cereb Stroke 41: 39–45, 2013), it is suggested that the mechanism of stabilization of carotid vulnerable plaque may
be different between EPA and statin.
