PMC4957603_01
Changes in lipid parameters (A) and lipoprotein parameters (B) at approximately one year and more than two years after switching from omega-3-acid ethyl esters (EPA + DHA) to icosapent ethyl (high-purity EPA). Patient was on stable doses of rosuvastatin and extended-release niacin. Percent changes shown are for icosapent ethyl compared with omega-3-acid ethyl esters treatment.. Abbreviations: DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; LDL-P, low-density lipoprotein particle concentration; non-HDL-C, non-high-density lipoprotein cholesterol; sdLDL-P, small dense low-density lipoprotein particle concentration; TC, total cholesterol; TGs, triglycerides; VLDL-C, very-low-density lipoprotein cholesterol.
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After 10 months on stable doses of omega-3-acid ethyl esters in combination with stable doses of rosuvastatin and extended-release niacin along with weight loss of approximately 13 lbs in the previous six to nine months, the patient's lipid profile revealed reduction in TG levels to 182 mg/dL (Table 1 and Fig. 1). (All lipid profiles were measured by nuclear magnetic resonance [NMR] spectroscopy by Cleveland Clinic Laboratories.) There were minimal to no improvements in non-HDL-C, TC, and HDL-C levels. After approximately one year of treatment with icosapent ethyl 4 g/day as add-on therapy to her original lipid-lowering regimen (stable rosuvastatin and extended-release niacin) and without any significant changes in weight to date, the patient's NMR lipid and lipoprotein profile showed substantial improvement compared with her lipid profile while on omega-3-acid ethyl esters treatment (Table 1 and Fig. 1): LDL-C level decreased by 52% to 80 mg/dL, TG level decreased by 29% to 130 mg/dL, non-HDL-C level decreased by 48% to 106 mg/dL, TC level decreased by 37% to 156 mg/dL, and HDL-C level increased by 19% to 50 mg/dL. The most recent follow-up NMR lipid profile for this patient demonstrated ongoing improvements in lipid parameter levels over 28 months with stable weight and continued icosapent ethyl add-on treatment (Table 1 and Fig. 1): LDL-C, 52 mg/dL; TG, 119 mg/dL; non-HDL-C, 76 mg/dL; and TC, 137 mg/dL.