Icosapent ethyl significantly reduces total ischemic events in patients with cardiovascular risk factors, including elevated triglycerides, who are on statins, according to results of the REDUCE-IT trial presented at ACC.19 in New Orleans. The results were simultaneously published in the Journal of the American College of Cardiology.

The REDUCE-IT trial previously showed that icosapent ethyl reduces the first occurrence of the primary composite endpoint of cardiovascular death, nonfatal myocardial infarction (MI), nonfatal stroke, coronary revascularization or hospitalization for unstable angina. In this REDUCE-IT analysis, Deepak L. Bhatt, MD, MPH, FACC, et al., explored the impact of icosapent ethyl on total ischemic events (first and subsequent events).

A total of 8,179 patients were randomized to icosapent ethyl 4 g/day or placebo and followed for a median of 4.9 years. The patients had fasting triglycerides of ≥135 mg/dL and <500 mg/dL and LDL-C >40 mg/dL and ≤100 mg/dL. Seventy-one percent of patients had a history of atherosclerosis and 29 percent had diabetes. Follow-up visits were scheduled at 4 months, 12 months and annually thereafter until 1,612 events occurred. The primary endpoint was the total of first plus subsequent ischemic events (cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization or hospitalization for unstable angina).

Overall, there were 2,909 primary endpoint events, with 1,606 (55.2 percent) first primary endpoint events and 1,303 (44.8 percent) additional primary endpoint events. Total primary endpoint event rates were reduced from 89 to 61 per 1000 patient-years for icosapent ethyl vs. placebo (p<0.0001). There was a 30 percent relative risk reduction in total ischemic events with icosapent ethyl, with a 32 percent reduction for second events, a 31 percent reduction for third events, and 48 percent reduction for fourth and more events. Total events for each component of the primary endpoint were also significantly reduced.

The investigators concluded that icosapent ethyl is an important treatment option to further reduce the total burden of atherosclerotic events beyond statin therapy alone.

Keywords: ACC19, ACC Annual Scientific Session, Ischemia, Hypertriglyceridemia, Eicosapentaenoic Acid, Angina, Stable

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