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Effects of Pemafibrate and Eicosapentaenoic Acid Ethyl Ester on Endothelial Function in Patients With

Trou Miyoshi1, Yasushi Matsuzawa2, Masayuki Doi3

  • 1Cardiovascular Medicine, Okayama University, Okayama, JPN.

Cureus
|April 24, 2025
PubMed

Insights

This study compares pemafibrate and eicosapentaenoic acid ethyl ester (EPA) for improving endothelial function in patients with coronary artery disease and hypertriglyceridemia. It assesses their impact on residual cardiovascular risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Vascular Biology

Background:

  • Residual cardiovascular risk persists despite statin therapy, with hypertriglyceridemia as a key contributor.
  • Selective peroxisome proliferator-activated receptor alpha modulators like pemafibrate and eicosapentaenoic acid ethyl ester (EPA) show promise in managing hypertriglyceridemia and cardiovascular health.
  • Endothelial dysfunction is a critical factor in atherosclerosis, yet comparative data on agents targeting hypertriglyceridemia is limited in coronary artery disease (CAD) patients.

Purpose of the Study:

  • To compare the efficacy of pemafibrate versus EPA in improving endothelial function in patients with CAD and hypertriglyceridemia.
  • To evaluate the impact of these treatments on residual cardiovascular risk markers.
  • To provide evidence for optimizing treatment strategies in this high-risk population.

Main Methods:

  • A multi-center, open-label, randomized trial (PRIME trial) was conducted.
  • Patients with CAD and hypertriglyceridemia on statin therapy were randomized to receive pemafibrate or EPA.
  • Endothelial function was assessed using the reactive hyperemia index (RHI) as the primary endpoint at 12 weeks.

Main Results:

  • The study is designed to assess the primary endpoint of change in RHI at 12 weeks.
  • Secondary endpoints include RHI changes at 24 weeks and correlations with lipid biomarkers and biochemical parameters.
  • Results will elucidate the comparative effects of pemafibrate and EPA on vascular function.

Conclusions:

  • This trial addresses a critical unmet need in managing residual cardiovascular risk in CAD patients with hypertriglyceridemia.
  • Findings will inform clinical practice regarding the use of pemafibrate and EPA for improving endothelial function.
  • The study aims to contribute to better therapeutic strategies for cardiovascular risk reduction.

Keywords:
cardiovascular riskeicosapentaenoic acidendothelial functionpemafibratetriglyceride

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