Topol is no dummy - he is one of the leading cardiologists.
At this point we've had multiple "plain old fish oil" studies, and the fairly strong conclusion to date is that they have little or no effect on top of a statin. (Except perhaps some effect on women and perhaps some effect on heart failure).
Now maybe Vascepa will prove different, whether because of plain EPA vs DHA/EPA mix or because of the higher dose, but until we see an actual outcomes study (on top of a statin) most doctors are going to remain skeptical. If Vascepa had a dramatic effect, then I think we would have seen at least a trend to efficacy here in what amounts to a lower-dose study of EPA.
But the bottom line in cardiology nowadays is there is justifiable scepticism of all biomarker studies. There have simply been too many disappointments where improved biomarkers did not lead to improved outcomes.
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