Thread by @VietHeartPA

#ACC21

Nice work #STRENGTHTrial team! #OM3

First - primary endpoints not achieved. This is a sub-study.

Questions attempted to address:
- Could higher EPA explain favorable outcomes?

- Could DHA component have exactly counterbalanced benefits of EPA?

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#ACC21
Recall #STRENGTHtrial randomized 13,000+. Similar MACE outcomes to #REDUCEIT.

STRENGTH sub-study looks at top tertile achieved EPA and DHA compared to corn oil.'
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#ACC21

-Interesting that high intensity statin use in top tertile was 10% less than other tertiles and corn oil group.

-LDL-C was 7 mg/dL higher in top tertile group than next highest (T1)

-Achieved EPA (443%) and DHA (68%) is c/w with dose 2200 mg, 800 mg respectively

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#ACC21

AF risk is real in OM3 use. Counsel/Discuss with your patients if deciding to use an OM3.

Remember though, in placebo, AF occurs too. Thus, recognize the background risk of AF regardless of OM3. Of course, decide whether EPA or EPA/DHA is beneficial or not 😉

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#ACC21

EPA/DHA formulation in STRENGTH showed high achieved levels of both. Top Tertiles show no impact either way for EPA or DHA on MACE

Note, in next tweet, the achieved levels are so well correlated, cannot separate DHA effect on EPA

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#ACC21

Correlation of achieved EPA and DHA in #STRENGTHTrial

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#ACC21

Limitations of this sub-study. These provide context to these important findings from Dr. Nissen and the STRENGTHTrial group.
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#ACC21

In an EPA/DHA mixed formulation in STRENGTH, (REDUCEIT is EPA-only).

EPA had 443% increase, DHA 68% increase.

While "no harm" is reported, this does not answer whether DHA "blunted" EPA benefit.
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#ACC21
Disclosure: Site investigator/co-author of EVAPORATE, oral abstract presented at ACC21 05/17 on Intermountain data looking at higher DHA level affect on EPA benefits.

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#ACC21

This STREGNTH sub-study looks at achieved levels in a mixed EPA/DHA formulation, we looked at whether circulating levels of EPA and DHA impact one another's effect on MACE. No spoilers, just read our title ;)