{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T15:50:35Z","timestamp":1762098635309,"version":"3.41.2"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,8,20]]},"abstract":"\n Background<\/jats:title>\n \n This study aimed to examine the impact of baseline eicosapentaenoic acid (\n EPA<\/jats:styled-content>\n ) to arachidonic acid (\n AA<\/jats:styled-content>\n ) ratio on clinical outcomes of patients with acute coronary syndrome.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n In the HIJ\u2010PROPER (Heart Institute of Japan Proper Level of Lipid Lowering With Pitavastatin and Ezetimibe in Acute Coronary Syndrome) study, 1734 patients with acute coronary syndrome and dyslipidemia were randomly assigned to pitavastatin+ezetimibe therapy or pitavastatin monotherapy. We divided the patients into 2 groups based on\n EPA<\/jats:styled-content>\n \/\n AA<\/jats:styled-content>\n ratio on admission (cutoff 0.34\u00a0\u03bcg\/mL as median of baseline\n EPA<\/jats:styled-content>\n \/\n AA<\/jats:styled-content>\n ratio) and examined their clinical outcomes. The primary end point comprised all\u2010cause death, nonfatal myocardial infarction, nonfatal stroke, unstable angina pectoris, or ischemia\u2010driven revascularization. Percentage reduction of low\u2010density lipoprotein cholesterol and triglyceride from baseline to follow\u2010up was similar regardless of baseline\n EPA<\/jats:styled-content>\n \/\n AA<\/jats:styled-content>\n ratio. Despite the mean low\u2010density lipoprotein cholesterol level during follow\u2010up being similar between the low\u2010 and high\u2010\n EPA<\/jats:styled-content>\n \/\n AA<\/jats:styled-content>\n groups, the mean triglyceride levels during follow\u2010up were significantly higher in the low\u2010 than in the high\u2010\n EPA<\/jats:styled-content>\n \/\n AA<\/jats:styled-content>\n group. After 3\u00a0years of follow\u2010up, the cumulative incidence of the primary end point in patients with low\n EPA<\/jats:styled-content>\n \/\n AA<\/jats:styled-content>\n was 27.2% in the pitavastatin+ezetimibe group compared with 36.6% in the pitavastatin\u2010monotherapy group (hazard ratio 0.69; 95%\n CI<\/jats:styled-content>\n , 0.52\u20100.93;\n P<\/jats:italic>\n =0.015). However, there was no effect of pitavastatin+ezetimibe therapy on the primary end point in patients with high\n EPA<\/jats:styled-content>\n \/\n AA<\/jats:styled-content>\n (hazard ratio 0.92; 95%\n CI<\/jats:styled-content>\n , 0.70\u20101.20;\n P<\/jats:italic>\n =0.52).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Among acute coronary syndrome patients who have dyslipidemia and low\n EPA<\/jats:styled-content>\n \/\n AA<\/jats:styled-content>\n ratio, adding ezetimibe to statin decreases the risk of cardiovascular events compared with statin monotherapy.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n http:\/\/www.umin.ac.jp\/ctr<\/jats:ext-link>\n . Unique identifier:\n UMIN<\/jats:styled-content>\n 000002742\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.119.012953","type":"journal-article","created":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T09:00:11Z","timestamp":1565254811000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Polyunsaturated Fatty Acid Impact on Clinical Outcomes in Acute Coronary Syndrome Patients With Dyslipidemia: Subanalysis of HIJ\u2010PROPER"],"prefix":"10.1161","volume":"8","author":[{"given":"Hiroyuki","family":"Arashi","sequence":"first","affiliation":[{"name":"Department of Cardiology The Heart Institute of Japan Tokyo Women's Medical University Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichi","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Heart Institute of Japan Tokyo Women's Medical University Tokyo 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