A 63-year-old man with a medical history significant for myocardial infarction (MI) 5 years ago presents to you for an annual exam. His medications include a daily aspirin, angiotensin-converting enzyme inhibitor, beta-blocker, and a high-intensity statin for coronary artery disease (CAD). On his fasting lipid panel, his low-density lipoprotein (LDL) level is 70 mg/dL, but his triglycerides remain elevated at 200 mg/dL despite dietary changes.
In addition to lifestyle modifications, what can be done to reduce his risk of another MI?
Patients with known cardiovascular disease (CVD) or multiple risk factors for CVD are at high risk of cardiovascular events, even when taking primary or secondary preventive medications such as statins.2,3 In these patients, elevated triglycerides are an independent risk factor for increased rates of cardiovascular events.4,5
The 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the treatment of blood cholesterol recommend statin therapy for moderate (175-499 mg/dL) to severe (≥ 500 mg/dL) hypertriglyceridemia in appropriate patients with atherosclerotic CVD risk ≥ 7.5%, after appropriately addressing secondary causes of hypertriglycidemia.6
Previous studies have shown no benefit from combination therapy with triglyceride-lowering medications (eg, extended-release niacin and fibrates) and statins, compared with statin monotherapy.7 A recent meta-analysis concluded that omega-3 fatty acid supplements offer no reduction in cardiovascular morbidity or mortality, whether taken with or without statins.8
Interestingly, the randomized controlled Japan EPA Lipid Intervention Study (JELIS) demonstrated fewer major coronary events in patients with elevated cholesterol, with or without CAD, who took eicosapentaenoic acid (EPA)—a subtype of omega-3 fatty acids—plus a statin, compared with statin monotherapy.9
The REDUCE-IT trial evaluated icosapent ethyl, a highly purified EPA that has been shown to reduce triglycerides and, at the time this study was conducted, was approved for use solely for the reduction of triglyceride levels in adults with severe hypertriglyceridemia.10,11
Continue to: Study Summary