Because benefits were similar across base- line triglycerides and unrelated to triglyceride levels attained, the mechanism by which IPE reduces MACEs, including secondary preven- tion of stroke, is unknown, possibly related to factors other than lowering triglycerides. The JELIS trial (Japan EPA Lipid Intervention found a 20% relative reduction of CLINICAL STATEMENTS AND GUIDELINES Kleindorfer stroke in hypercholesterolemic patients treated with IPE, an ester derivative of eicosapentae- noic acid (EPA), and low-dose statin. Two stud- ies, the STRENGTH trial (Outcomes Study to Assess Statin Residual Risk Reduction With Epanova in High CV Risk Patients With and the OMEMI trial (Omega-3 Fatty Acids in Elderly Patients With Acute Myocardial Infarction)225 (underpow- ered), found no benefit from combined EPA/ docosahexaenoic acid (DHA) in patients with high CVD risk, diabetes, or CVD. Treatment with EPA/DHA resulted in lower median blood EPA levels in STRENGTH than those achieved by treatment with IPE in REDUCE-IT, which had a 25% reduction in the primary end point. Because triglyceride levels were similar, higher EPA levels may account for the results seen in REDUCE-IT. In addition, the differing effects of EPA and DHA on membrane stabilization may contribute to the lack of effect with EPA/DHA compared with EPA alone or IPE. 2. Most patients with triglycerides 500 mg/dL ( 5.6 mmol/L) have increased VLDL and chylomicrons. Increased chylomicrons occur when triglycerides are 500 mg/dL ( 5.6 mmol/L). With increasing triglycer- ide concentrations, chylomicronemia may intensify and cause acute pancreatitis. Higher triglycerides levels convey greater risk.222 Patients with triglycerides from 500 to 999 mg/dL are at risk of developing unrec- ognized marked increases in triglycerides, leading to pancreatitis. 