NEW YORK (Reuters Health) – In patients with mixed dyslipidemia, adding prescription omega-3 acid ethyl esters (P-OM3) to simvastatin further improves lipid and lipoprotein levels, according to a report in the August 15th issue of the American Journal of Cardiology.

“The efficacy of the simvastatin/omega-3 combination is similar to that observed with simvastatin/fenofibrate,” Dr. Kevin C. Maki from Provident Clinical Research, Glen Ellyn, Illinois told Reuters Health. “Therefore, my view is that the combination is a reasonable treatment option for individuals with mixed dyslipidemia.”

Dr. Maki and colleagues evaluated 6 weeks of therapy with simvastatin 20 mg/day plus P-OM3 4 g/day or placebo in 39 patients with elevated triglyceride and non-HDL cholesterol.

Non-HDL cholesterol concentration declined to a greater degree with simvastatin+P-OM3 (40% decrease) than with simvastatin+placebo (34% decline), the authors report.

The P-OM3 group also experienced greater declines in VLDL cholesterol and triglyceride and greater increases in HDL cholesterol than did the placebo group.

Significantly greater improvements with P-OM3 than with placebo were seen in apoB, total cholesterol to HDL cholesterol ratio, and triglyceride to HDL cholesterol ratio, the researchers note, but LDL cholesterol and apoA-I levels changed to a similar degree with the two treatments.

Most adverse events were classified as mild or moderate in severity, the investigators say, and there were no serious adverse events related to the treatment.

“My larger message is the importance of treating to the National Cholesterol Education Program goals for both LDL and non-HDL cholesterol,” Dr. Maki said. “The results from our NEPTUNE II survey suggest that about 25% of individuals undergoing treatment for dyslipidemia have elevated triglycerides (at least 200 mg/dL). We have made great progress in treating patients to their LDL cholesterol goals over the last decade, but a significant percentage of patients have not achieved their non-HDL cholesterol goals.”

“Evidence from a variety of sources indicates that each 1 mg/dL increase in VLDL cholesterol is associated with an increase in coronary heart disease risk similar to that for each 1 mg/dL increase in LDL cholesterol, explaining why non-HDL cholesterol is a better predictor of event risk than LDL cholesterol,” Dr. Maki added. “Additional attention is needed in clinical practice to recognizing and treating elevated non-HDL cholesterol.”

Am J Cardiol 2008;102:429-433.

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