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Machado NM, Oliveira MVB, Quesada K, Haber JFDS, José Tofano R, Rubira CJ, Zutin TLM, Direito R, Pereira EDSBM, de Oliveira CM, Goulart RDA, Valenti VE, Sloan KP, Sloan LA, Laurindo LF, Barbalho SM. Assessing Omega-3 Therapy and Its Cardiovascular Benefits: What About Icosapent Ethyl? A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel) 2025; 18:601. [PMID: 40284036 PMCID: PMC12030327 DOI: 10.3390/ph18040601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2025] [Revised: 04/14/2025] [Accepted: 04/16/2025] [Indexed: 04/29/2025] Open
Abstract
Background: Lipid-lowering therapies are an option for stabilizing lipid levels. Icosapent ethyl (IPE) is a highly purified formulation of eicosapentaenoic acid, which can reduce lipid action, improve plaque stabilization, reduce platelet aggregation, lower TG, and prevent cardiovascular events. IPE is frequently used with statins to manage elevated TG levels. However, the evidence on IPE as a lipid-lowering agent is limited, and no updated systematic review and meta-analysis have been published considering the recent advancements in the field and newly published studies. Therefore, we aim to fill this gap. Methods: We used the PRISMA guidelines and the PICO (Population, Intervention, Comparison, and Outcome) framework to conduct this review, aiming to answer the question, "Can IPE benefit patients at cardiovascular risk?" GRADE was used to evaluate evidence levels to adhere to the highest criteria. Results: Predominantly, the evaluated population presented TG levels between ≥135 mg/dL and 500 mg/dL and LDL-C levels between >40 mg/dL and ≤100 mg/dL. The included studies showed a reduction in TG and LDL-C and a decrease in cardiovascular events. It means that, according to our systematic review evidence analysis, IPE has been effective in lowering blood lipid levels, including TG, and reducing cardiovascular death and events, such as non-fatal stroke or hospitalization for unstable angina. However, it is worth noting that these results were primarily from patients undergoing statin therapy. According to our meta-analysis, IPE may not be considered a lipid-lowering drug, as limited action associated with its use was evident in the quantitative results. However, caution is necessary, as only two studies were suitable for inclusion due to the differing outcomes in the analyzed samples. Conclusions: Despite the quantitative synthesis, IPE possesses anti-inflammatory, anti-thrombotic, and anti-atherogenic properties, highly related to cardiovascular protection. Based on our included studies, IPE was considered a promising therapy for atherosclerotic cardiovascular disease in conjunction with other lipid-lowering therapies, particularly statins, for patients with extremely high TG levels. The limitations of the reviewed studies may include small sample sizes, varying outcomes, and a small duration of interventions. Future clinical trials with similar outcomes, sample sizes, and intervention durations must be designed, and updated meta-analyses must be published in the following years to fully assess the effects of IPE as a lipid-lowering and cardiovascular protector drug.
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Affiliation(s)
- Nathália Mendes Machado
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
| | - Maria Vitória Barroso Oliveira
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
| | - Karina Quesada
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil
| | - Jesselina Francisco dos Santos Haber
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
| | - Ricardo José Tofano
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil
| | - Claudio José Rubira
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
| | - Tereza Lais Menegucci Zutin
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil
| | - Rosa Direito
- Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines, Universidade de Lisboa (iMed.ULisboa), Av. Prof. Gama Pinto, 1649-003 Lisbon, Portugal
| | | | - Camila Marcondes de Oliveira
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
| | - Ricardo de Alvares Goulart
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil
| | - Vitor Engrácia Valenti
- Faculty of Philosophy and Sciences, Universidade Estadual Paulista (UNESP), Marília 17525-900, São Paulo, Brazil
| | - Kátia Portero Sloan
- Department of Clinical Metabolism, Texas Institute for Kidney and Endocrine Disorders (TIKED), Lufkin, TX 75904, USA
| | - Lance Alan Sloan
- Department of Clinical Metabolism, Texas Institute for Kidney and Endocrine Disorders (TIKED), Lufkin, TX 75904, USA
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil
| | - Sandra Maria Barbalho
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil (R.d.A.G.); (L.F.L.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil
- Research Coordination, UNIMAR Charitable Hospital, Marília 17525-902, São Paulo, Brazil
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Gallo Ruelas M, Queiroz I, Pimentel T, Tavares AH, Defante MLR, Barbosa LM, Eckert I. Effects of seal oil supplementation on lipid profile biomarkers: A systematic review and meta-analysis of randomized controlled trials. Prostaglandins Leukot Essent Fatty Acids 2025; 204:102666. [PMID: 39914123 DOI: 10.1016/j.plefa.2025.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Revised: 01/26/2025] [Accepted: 01/27/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND Seal oil (SO) supplementation has been purported to have cardiovascular health benefits due to its content of omega-3 fatty acids; however, the clinical evidence base for this intervention has yet to be comprehensively assessed. OBJECTIVE We aimed to evaluate the effects of oral SO supplementation on lipid profile biomarkers. METHODS A systematic search was performed on Pubmed, Embase, Web of Science and Cochrane Library, from inception to August 2024. Only randomized controlled trials (RCTs) assessing the effect of SO on lipid profile biomarkers were included. A random-effects meta-analysis was applied to determine the overall effect estimate. The certainty of evidence (CoE) was evaluated using the GRADE approach. RESULTS Nine RCTs were included in the review after the screening of 242 studies, comprising a total of 626 patients. Supplementation of SO resulted in no statistically significant effects on LDL-C (MD -0.07 mmol/L; 95 % CI [-0.19, 0.05]; CoE: Low) and total cholesterol (MD -0.12 mmol/L; 95 % CI [-0.30, 0.06]; CoE: Very low). There were statistically significant results of modest-to-trivial clinical importance on triglycerides (MD -0.19 mmol/L, 95 % CI [-0.30, -0.08]; CoE: Low) and trivial importance on HDL-C (MD 0.07 mmol/L, 95 % CI [0.003, 0.13]; CoE: Very low). CONCLUSION There is no sufficiently certain evidence to determine the effects of SO on cardiovascular lipid biomarkers. Our analyses may suggest a modest-to-trivial, clinically uncertain beneficial effect on triglyceride levels; and little to no effect on LDL-C. Effect estimates for HDL-C and total cholesterol levels were highly uncertain. Further evidence is required to conclusively determine the effects of oral SO on lipid biomarkers. PROTOCOL REGISTRATION NUMBER CRD42024583739.
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Affiliation(s)
| | - Ivo Queiroz
- Catholic University of Pernambuco, Medicine Department, Brazil
| | - Túlio Pimentel
- Federal University of Pernambuco, Medicine Department, Brazil
| | | | - Maria L R Defante
- Redentor University Center, Medicine Department, Itaperuna, Rio de Janeiro, Brazil
| | | | - Igor Eckert
- Independent Researcher, Porto Alegre, Brazil
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Yin Y, Zhang L, Zhang J, Jin S. Predictive value of uric acid to albumin ratio for carotid atherosclerosis in type 2 diabetes mellitus: A retrospective study. PLoS One 2025; 20:e0320738. [PMID: 40153388 PMCID: PMC11952251 DOI: 10.1371/journal.pone.0320738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 02/24/2025] [Indexed: 03/30/2025] Open
Abstract
BACKGROUND This study aims to evaluate the correlation between the uric acid (UA) to albumin (ALB) ratio (UAR) and carotid atherosclerosis (CAS) in patients with type 2 diabetes mellitus (T2DM), as well as to assess the predictive value of UAR for CAS. METHODS A cross-sectional, single-center study was conducted, retrospectively analyzing hematological parameters from 259 T2DM patients with CAS (T2DM-CAS) and 131 T2DM patients without CAS (T2DM-WCAS). Carotid intima-media thickness (IMT) and carotid plaques (CAP) were measured using Doppler ultrasound. RESULTS The UAR level in the T2DM-CAS group was significantly higher than that in the T2DM-WCAS group (P < 0.001). Multivariate logistic regression analysis revealed that UAR is an independent risk factor for T2DM-CAS (P < 0.001). The area under the ROC curve (AUC) for UAR in predicting T2DM-CAS was 0.712, with a Youden index of 0.278. CONCLUSION High levels of UAR are closely associated with the occurrence of T2DM-CAS and may serve as a useful biomarker for predicting T2DM-CAS.
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Affiliation(s)
- Yao Yin
- Department of Endocrinology, Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liyin Zhang
- Department of Endocrinology, Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaoyue Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Si Jin
- Department of Endocrinology, Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kozakova M, Morizzo C, Penno G, Chiappino D, Palombo C. Diabetes-Related Changes in Carotid Wall Properties: Role of Triglycerides. J Clin Med 2024; 13:5654. [PMID: 39337141 PMCID: PMC11433327 DOI: 10.3390/jcm13185654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/07/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: This study compares the power of the radiofrequency (RF) signal reflected from the media layer (media power) of the common carotid artery (CCA) and the CCA stiffness between individuals with and without type 2 diabetes mellitus (T2DM). It also evaluates the associations of CCA media power with plasma glucose and lipid levels, as well as carotid stiffness. Methods: A total of 540 individuals, 115 with and 425 without T2DM (273 males, mean age = 64 ± 8 years) were studied using RF-based tracking of the right CCA. The following parameters were measured: CCA media thickness, luminal diameter, wall tensile stress (WTS), local pulse wave velocity (PWV), and media power. Results: Compared to the non-diabetic individuals, the T2DM patients had significantly higher CCA media thickness (652 ± 122 vs. 721 ± 138 microns, p < 0.005), luminal diameter (6.12 ± 0.78 vs. 6.86 ± 0.96 mm, p < 0.0005), media power (36.1 ± 4.8 vs. 39.3 ± 4.6, p < 0.0001), and PWV (7.65 ± 1.32 vs. 8.40 ± 1.89 m/s; p < 0.01), but comparable WTS (32.7 ± 10.4 vs. 33.1 ± 10.7 kPa; p = 0.25). In the entire population, CCA media power was independently associated with male sex, pulse pressure, current smoking, and T2DM; when T2DM was not included in the model, triglycerides emerged as an independent determinant of media power. The CCA PWV was independently associated with age, pulse pressure, media power, and T2DM. Conclusions: Our findings suggest the presence of structural changes in the arterial media of T2DM patients, leading to carotid stiffening and remodeling, aiming to preserve WTS. T2DM-related changes in arterial wall composition may be driven by high plasma triglyceride levels, which have previously been associated with both arterial stiffening and the incidence of CV events.
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Affiliation(s)
- Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.K.); (G.P.)
- Esaote SpA, 16153 Genova, Italy
| | - Carmela Morizzo
- School of Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Giuseppe Penno
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.K.); (G.P.)
| | - Dante Chiappino
- Fondazione Toscana G. Monasterio, Massa-Pisa, 56124 Pisa, Italy;
| | - Carlo Palombo
- School of Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy
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Yamashita S, Hirano T, Shimano H, Tsukamoto K, Yoshida M, Yoshida H. Managing hypertriglyceridemia for cardiovascular disease prevention: Lessons from the PROMINENT trial. Eur J Clin Invest 2024; 54:e14227. [PMID: 38662591 DOI: 10.1111/eci.14227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/14/2024] [Accepted: 04/06/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Numerous epidemiological studies have shown that hypertriglyceridemia is a significant risk factor for cardiovascular diseases (CVD). However, large clinical studies on triglyceride-lowering therapy have yielded inconsistent results. In the current review, we reassess the importance of triglyceride-lowering therapy in preventing CVD based on previous literature and the recently published findings of the PROMINENT trial. METHODS This narrative review is based on literature and public documents published up to November 2023. RESULTS Meta-analyses of trials on peroxisome proliferator-activated receptor α agonists and triglyceride-lowering therapy, including the PROMINENT trial, have indicated that triglyceride-lowering therapy can reduce CVD events. Mendelian randomization studies have also indicated that triglyceride is indeed a true risk factor for coronary artery disease, leaving no doubt about its relationship to CVD. Meanwhile, the negative results from the PROMINENT trial were likely due to the insufficient triglyceride-lowering effect, slight increases in low-density lipoprotein cholesterol and apolipoprotein B, and the inclusion of mostly high-intensity statin users as target patients. It is unlikely that adverse events counteracted the effectiveness of pemafibrate on outcomes. Additionally, pemafibrate has shown positive effects on non-alcoholic fatty liver disease and peripheral artery disease. CONCLUSION Although the PROMINENT trial did not demonstrate the significance of pemafibrate as a triglyceride-lowering therapy in a specific population, it does not necessarily negate the potential benefits of treating hypertriglyceridemia in reducing CVD events. It is necessary to explore appropriate populations that could benefit from this therapy, utilize data from the PROMINENT trial and other databases, and validate findings in real-world settings.
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Affiliation(s)
| | - Tsutomu Hirano
- Diabetes Center, Ebina General Hospital, Ebina, Kanagawa, Japan
| | - Hitoshi Shimano
- Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazuhisa Tsukamoto
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Medical Genetics, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Life Science and Bioethics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Yoshida
- Section of Internal Medicine of Metabolism and Nutrition, The Jikei University Graduate School of Medicine, Tokyo, Japan
- Department of General Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan
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Wang Y. Fasting Triglycerides in the Upper Normal Range Are Independently Associated with an Increased Risk of Diabetes Mortality in a Large Representative US Population. J Cardiovasc Dev Dis 2024; 11:128. [PMID: 38667746 PMCID: PMC11050947 DOI: 10.3390/jcdd11040128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
The association between normal-range triglyceride levels and diabetes mortality remains unclear. This cohort study aimed to elucidate this relationship by examining 19,010 US adult participants with fasting serum triglycerides below 150 mg/dL. Cox proportional hazards models were employed to estimate mortality hazard ratios (HRs) and 95% confidence intervals (CIs). Participants were followed up for a mean of 15.3 years, during which 342 diabetes deaths were recorded. A 1 natural log unit increase in triglycerides was associated with a 57% higher risk of diabetes mortality (adjusted HR, 1.57; 95% CI, 1.04-2.38). Comparable results were obtained when triglycerides were analyzed in quartiles. Receiver operating characteristic curve analysis identified an optimal triglyceride cutoff of 94.5 mg/dL for diabetes mortality; individuals with triglyceride levels above this threshold faced a greater risk of diabetes mortality (adjusted HR, 1.43; 95% CI, 1.12-1.83). Further investigation revealed a positive association between normal triglyceride levels and all-cause mortality, though no association was observed between normal triglycerides and mortality from hypertension or cardiovascular disease. In conclusion, elevated triglyceride levels within the normal range were associated with an increased risk of diabetes mortality. Individuals with triglyceride levels of 95 mg/dL or higher may require vigilant monitoring for diabetes and its associated complications.
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Affiliation(s)
- Yutang Wang
- Discipline of Life Science, Institute of Innovation, Science and Sustainability, Federation University Australia, Ballarat, VIC 3350, Australia
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