Effect of Vascepa on Improving Coronary Atherosclerosis in People With High Triglycerides Taking Statin Therapy

Residual cardiovascular (CV) risk remains in dyslipidemic patients despite intensive statin
therapy, underscoring the need for additional intervention. Eicosapentaenoic acid (EPA), an
omega-3 polyunsaturated fatty acid, is incorporated into membrane phospholipids and
atherosclerotic plaques and exerts beneficial effects on the pathophysiologic cascade from
onset of plaque formation through rupture. EPA also improves atherogenic dyslipidemia
characterized by reduction of triglycerides without raising low-density lipoprotein
cholesterol. All of this data supports the biologic plausibility of EPA as an
anti-atherosclerotic agent. The goal of this study is to evaluate whether treatment with
Vascepa (4 grams) results in a greater change from baseline in low attenuation plaque than
placebo in subjects with elevated triglycerides (200-499 mg/dl).

Inclusion Criteria:

- Elevated triglycerides (fasting value between 200-499 mg/dl) at qualifying or baseline
visit.

- LDL-C ≤115 mg/dL on appropriate statin therapy

- LDL-C >40 mg/dL

- Stable diet and exercise, as defined as the same pattern for the previous 4 weeks

- Stable treatment with a statin+/- ezetimibe for at least 4 weeks

- Patients with at least 1 angiographic stenosis with at least 20% narrowing by coronary
computed tomography angiography (CTA).

- Willingness to be on birth control for women of childbearing age or established
post-menopausal

Exclusion Criteria:

- A contraindication to fish or fish oils including: known hypersensitivity to drug or
fish.

- Any unstable medical, psychiatric or substance abuse disorder that in the opinion of
the investigator or principal investigator is likely to affect the subject's ability
to complete the study or precludes the subject's participation in the study.

- Non-study lipid altering medications or supplements (ie - Niacin, PCSK9, fibrates,
bile acid Sequestrants, dietary fish oil supplement capsules, orlistat [OTC (Alli®) as
well as Rx (Xenical®)] or other drugs used for weight loss).

- Stable (same daily dose for the last 4 weeks) on medications that can affect lipids
(retinoids, hormones, steroids, HIV medications, chemotherapy, thyroid medications).

- BMI > 40

- Bleeding disorder

- Uncontrolled hypertension (SBP≥ 180 mmHg or DBP≥100 mmHg)

- History of known myocardial infarction, stroke or life-threatening arrhythmia within
the prior six months.

- NYHA Class III- IV heart failure

- History of malignancy within the last 5 years (other than skin cancer) or evidence of
active cancer which would require concomitant cancer chemotherapy.

- Serum creatinine > 1.4 mg/dl

- Drug or alcohol abuse, or current intake of more than 14 ounces of alcohol per week
for men and 10 ounces for women

- Concurrent enrollment in another placebo-controlled trial or within 30 days of
finishing another trial

- Partial ileal bypass or known gastrointestinal disease limiting drug absorption

- History of hypertensive encephalopathy or cerebrovascular accident

- Hematological or biochemical values at screening outside the reference ranges
considered as clinically significant in the opinion of the investigator or PI

- Pregnancy

- Genetic mutations/polymorphisms having an effect on blood lipids

- History of coronary artery bypass surgery

- Allergy to contrast material

- Allergy to beta-blocker in subjects with resting heart rate >70 bpm