"why did not Jelis lead to it being a big deal in Japan?"
Great question.
First of all you have to understand medicine is a universal language and the language is American. So even though JELIS was a japanese study the important critics were americans. JELIS was badly misinterprete by the AHA reviewers. Then first thing they noted was it was not a double blind study, the second was the statin doses used in JELIS were very low compared to those used in the USA and the AHA reviewers argued a similar reduction in CVD event reduction could have been produced by increasing the statin doses.
The americans did not appreciate the JELIS numbers and minimalised the CVD reductions, noting no statistically significant improvement in all cause mortality. The real reason for lack of stat sig was the fact the japanese population had only about a 0.8% annual event rate and this was too low a risk to produce significant numbers without having tens of thousands of patients.
One of the two AHA reviewers Dwarvish (from Harvard Med School) made the erroneous statement that "fish oil" works in a threshold manner, ie. you need a small amount, and once you reach that amount, adding more would result in no further benefit. He used this self invented notion to explain why the japanese had lower CVD risk than americans, but upping their EPA would not improve their health. This was gourmet BS..We now understand EPA's effects are dose dependent.
The real value of taking large (4 gm) doses of EPA is to improve the EPA/AA ratio. In Japan at the time of JELIS their EPA/AA ratio was much more healthy that ours and that was reflected in their lower risk rate. Many more in the USA are at much higher risk than the JELIS group, and the REDUCE-IT group is higher than the american average. Consequently the risk reduction will be higher in REDUCE-IT and a very big deal..
":>) JL
PS..Feel free to sell your shares.
