Amarin Corp Plc (AMRN)

[jessellivermore]

Wha..

Very good. I was not aware that the LDL-C was significantly higher in the secondary intervention group, not 130 which was the study average, but actually 48mg higher. Thank you for providing this very important piece of the puzzle.

So what does this mean?

It mean that the epa/AA ratio is more important than I thought, and the LDL-C measurement is less important than I thought. How so? Well The secondary intervention subset in JELIS is like the REDUCE-IT patients in terms of having documented coronary artery disease. If we surmise that LDL-C levels are a prime risk factor (the statin argument) then considering two separate groups having prior CVD history, one group with an average LDL-C of 100 and the second group with an average LDL-C of 178, then certainly the group with the higher 178 number should be at greater risk. But alas, this is not the case in this instance. No, the REDUCE-IT group with avg. LDL-C of 100 has a annual risk of 5.2-5.9% and the JELIS group with avg. LDL-C of 178 has a much lower risk of 2.2%.

This paradox is something that not only I, but the AHA reviewers missed. We can thank Whalane for noticing it.

So what is the explanation for the apparent paradox?..Well the evidence points to the second difference between the two groups, and that is the difference in EPA/AA ratios. The japanese in JELIS had pre treatment EPA/AA ratios which were in the neighborhood of 6-7 times higher than those in REDUCE-IT. This is very strong evidence that the EPA/AA ratio is a much more important determiner of CVD risk than LDL-C and could be considered the "smoking gun" in the statin trial..

Thank you KIWI..you have made my point.

":>) JL