iwfal
Quote: "As for Jelis, you mean that trial where the treatment arm had more deaths than the placebo arm? (Did I get that right wink.)"
Nope...Sounds like you are using Pyrr for your source...
JELIS is complicated and nuanced and requires a lot of study to extract meaningful information...Let me suggest you read post 11548 to begin with.
JELIS seems a large trial by R-I standards more than 18,000 enrollees which is well over twice R-Is...But numbers deceive and as you know its all about events...
The annual CVD event rate for the JELIS trial was 0.8% which yielded only 586 events for the whole five years..That's closer to an acne trial than R-I..Then you have to consider the fact that of the patients in the secondary prevention subset (about 3660).. who are the only group comparable to R-I patients..two thirds of them were there on the basis of a diagnosis of angina pectoris..This is further confounded by the fact the majority of these "angina" patients may have had a variety of angina typical in Western Asia that is not caused by atherosclerosis, but is brought on by vasospasm of sympathetic nerve origin.
Looking at data for the whole JELIS cohort does not provide much insight into R-I...My estimate is less than 20% of the JELIS cohort would qualify for R-I selection..Virtually every JELIS enrollee had better EPA/AA ratios than the every R-I enrollee...And this is reflected in paucity of CVD events and lower annual event rates in JELIS. In the secondary prevention subset of JELIS (about 22% of the cohort) There were more CVD events (355) than there were in the remaining 78% (231)..Still there were only 39 coronary death in the secondary prevention group...21 in the placebo arm..18 in the EPA arm..
It is clear CVD annual event risk was very low in JELIS...The conclusion is if someone dies in JELIS there is a very good chance it was from something other than CVD...Therefore learning that all cause mortality in JELIS was the same in both arms is not surprising. But this doesn't mean that's going to be the case in R-I where CVD will certainly be the majority cause of death,,
Finally...What is really the most important point is that CVD risk is inversely proportional to the EPA/AA ratio. And JELIS confirms this...It was born out by measuring individuals in JELIS..Imagine running an American JELIS...Selecting cohorts adjusted for age, gender, blood chemistries (except EPA/AA ratios) and past medical history..We can say for a fact the annual CVD risk rates in both the primary and secondary prevention groups are going to be at least two percent points higher..than those in the Japanese JELIS...And we know from Japanese coming to America and lowering their EPA/AA ratios that this is not a genetic effect....
":>) JL
