Tiny bit of history: At age 32 my HDLs were 25, and my Dr told me any lower, and he'd classify me as a coronary patient. Recommended aerobic exercise.
At age 66: Total Cholesterol 155. HDL 75. VLDL 11. LDL Calc 65. Triglycerides 55. Ratio of LDL:HDL 0.9 where 1-1.5 is 1/2 ave risk. Obviously my HDL being high isn't related to genetics all of a sudden. Can't jog with a large toe compression fracture - too many times my prior dogs stepped on it. And I really like my greasy diet - no dietary restrictions.
So what explains it? Hint : Compare the cost of Nature Made (or some other favorite) fish oil sold at Walmart. Compare to the cost of the AMRN drug month supply to a month supply of Fish Oil? Where the daily dose of Fish Oil is 9000 mg/d: 3000 mg AM, 3000 mg PM, 3000 mg before bed. The Omega 3s (EPA) raise HDLs, while hitting the Triglycerides hard. There's one missing component - slow release Niacin (SLO brand): 1000 mg at bedtime, 500 mg in the morning. Some folks do have liver problems with Niacin, but my liver ain't worried after 30 yrs of taking it. Liver panels are recommended for starters- assuming one's Dr doesn't pitch a fit about it. The Niacin inhibits the breakdown of the HDLs by the liver. And also hits production of the VLDLs. Add in the cost of Niacin, and it's still a bargain over the AMRN drug.
So, in the clinical trial how did the AMRN purified EPA+Statins compare to the control arm of 9000 mg/d of Fish Oil+Statins??? Oh, that's right, there never was a control arm of generic Fish Oil+Statins. About the only credit I give AMRN is they acknowledge the EPA of 9000 mg of Fish oil is equivalent to their "purified" EPA in their "drug". Trick question: What's the difference between synthetic EPA derived from fish oil, and naturally occurring EPA in the fish oil? Answer: None. The structure of EPA is the same in either case.
The case AMRN makes for its purified EPA drug is that it lowers Triglycerides. But so does Fish oil. The problem for fish oil are the Drs telling patients taking 1000-2000 mg/d. Not enuff to doo anything!
Ooh but my fish oil story has never been tested at 9000 mg in a CT, and can't be verified. Correct! Butt if one is into CTs, looking at Triglycerides, then there are some very interesting drugs in the pipeline. My favorites are the thyroid hormone beta agonists. See MDGL, and its little brother VKTX. There are other classes of drugs like my ill begotten GEMP being terrorized by the FDA wanting more animal carcinogenicity studies before releasing a partial halt on a pile of Ph 2 trials.
In summary don't see the market potential for the AMRN drug. Either on the cost or ultimately effectiveness of the curve. Butt hay, if you got in at a good entry price, ya might as well ride the hype to whatever level it goes.