Effect of Eicosapentaenoic Acid/Docosahexaenoic Acid on Coronary High-Intensity Plaques Detected Using Noncontrast T1-weighted Imaging: The AQUAMARINE EPA/DHA Randomized Study.

AIM: Omega-3 fatty acids have emerged as a new option for controlling the residual risk for coronary artery disease (CAD) in the statin era. Eicosapentaenoic acid (EPA) is associated with reduced CAD risk in the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention trial, whereas the Statin Residual Risk with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia trial that used the combination EPA/docosahexaenoic acid (DHA) has failed to derive any clinical benefit. These contradictory results raise important questions about whether investigating the antiatherosclerotic effect of omega-3 fatty acids could help to understand their significance for CAD-risk reduction. METHODS: The Attempts at Plaque Vulnerability Quantification with Magnetic Resonance Imaging Using Noncontrast T1-weighted Technic EPA/DHA study is a single-center, triple-arm, randomized, controlled, open-label trial used to investigate the effect of EPA/DHA on high-risk coronary plaques after 12 months of treatment, detected using cardiac magnetic resonance (CMR) in patients with CAD receiving statin therapy. Eligible patients were randomly assigned to no-treatment, 2-g/day, and 4-g/day EPA/DHA groups. The primary endpoint was the change in the plaque-to-myocardium signal intensity ratio (PMR) of coronary high-intensity plaques detected by CMR. Coronary plaque assessment using computed tomography angiography (CTA) was also investigated. RESULTS: Overall, 84 patients (mean age: 68.2 years, male: 85%) who achieved low-density lipoprotein cholesterol levels of ＜100 mg/dL were enrolled. The PMR was reduced in each group over 12 months. There were no significant differences in PMR changes among the three groups in the primary analysis or analysis including total lesions. The changes in CTA parameters, including indexes for detecting high-risk features, also did not differ. CONCLUSION: The EPA/DHA therapy of 2 or 4 g/day did not significantly improve the high-risk features of coronary atherosclerotic plaques evaluated using CMR under statin therapy.

Modelos animales de reparación vascular y reendotelización / Animal models of vascular repair and re-endothelialization

La investigación experimental se vale de modelos animales para analizar la seguridad y la eficacia de distintos tratamientos propuestos por la investigación básica antes de su análisis en ensayos clínicos. En el terreno de los dispositivos para el tratamiento de la enfermedad coronaria, la investigación traslacional adquiere gran relevancia tras el fenómeno de la trombosis tardía de los stents farmacoactivos: aunque en su primer análisis preclínico ya se observaron fenómenos de retraso en la reparación vascular, su uso extendido descubrió la citada complicación tardía. En un movimiento de vuelta al análisis preclínico, se cambió el foco de estudio desde la eficacia antirreestenótica de estos nuevos dispositivos a la seguridad en la reparación vascular. Se revisan los distintos modelos animales (especialmente porcino y de conejo), tanto normales como con enfermedad inducida, de valor en el análisis preclínico de los stents coronarios, con particular énfasis en el estudio de la endotelización y de la reparación vascular. La correlación de los hallazgos obtenidos en estos modelos con las observaciones realizadas en necropsias humanas refuerza el concepto de investigación traslacional (AU)

Preclinical research employs animal models to investigate the safety and efficacy of treatments suggested by basic research before they are studied in clinical trials. With regard to devices for treating coronary artery disease, translational research has become very important for the study of late thrombosis in drugeluting stents: although delayed vascular healing had already been observed in early preclinical trials, this late complication was only fully revealed with extensive use of the devices. In the return to preclinical studies, the focus of research has shifted from the efficacy of these new devices in preventing restenosis to the reliability of vascular repair. This article contains a review of the different animal models (especially pigs and rabbits), whether involving healthy animals or those with induced disease, that are useful for the preclinical assessment of coronary stents, particularly for the study of endothelialization and vascular repair. The observed agreement between findings in these models and findings in human necropsies confirms the value of translational research (AU)