Consider this Rx for patients with high triglycerides?
A daily dose of this prescription fish oil may be worth a trial in light of the cardiovascular benefits it affords statin-treated patients with high triglycerides.
PRACTICE CHANGER
Consider icosapent ethyl, 2 g twice daily, for secondary prevention of adverse cardiovascular events in patients with elevated triglycerides who are already taking a statin.
STRENGTH OF RECOMMENDATION
B: Based on a single, good-quality, multicenter, randomized controlled trial. Bhatt DL, Steg PG, Miller M, et al; REDUCE-IT Investigators. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380:11-22.1
Bhatt DL, Steg PG, Miller M, et al; REDUCE-IT Investigators. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380:11-22.1
STUDY SUMMARY
Patients with known CVD had fewercardiovascular events on icosapent ethyl
The multicenter, randomized controlled REDUCE-IT trial evaluated the effectiveness of icosapent ethyl, 2 g orally twice daily, on cardiovascular outcomes.1 A total of 8179 patients, ≥ 45 years of age with hypertriglyceridemia and known CVD or ≥ 50 years with diabetes and at least 1 additional risk factor and no known CVD, were enrolled at 473 participating sites in 11 countries, including the United States.
Patients had a triglyceride level of 150 to 499 mg/dL and an LDL cholesterol level of 41 to 100 mg/dL, and were taking a stable dose of a statin for at least 4 weeks. The enrollment protocol was amended to increase the lower limit of triglycerides from 150 to 200 mg/dL about one-third of the way through the study. Among the study population, 70.7% of patients were enrolled for secondary prevention (ie, had established CVD) and 29.3% of patients were enrolled for primary prevention (ie, had diabetes and at least 1 additional risk factor but no known CVD). Exclusion criteria included severe heart failure, active severe liver disease, glycated hemoglobin > 10%, a planned surgical cardiac intervention, history of pancreatitis, or allergies to fish or shellfish products.
Outcomes. The primary end point was a composite outcome of cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina.
Results. The median duration of follow-up was 4.9 years. From baseline to 1 year, the median change in triglycerides was an 18% reduction in the icosapent ethyl group but a 2% increase in the placebo group. Fewer patients in the icosapent ethyl group than the placebo group had a composite outcome event (17% vs 22%, respectively; hazard ratio [HR] = 0.75; 95% confidence interval [CI], 0.68-0.83; number needed to treat [NNT] to avoid 1 primary end point event = 21). Patients with known CVD had fewer composite outcome events in the icosapent ethyl group than the placebo group (19% vs 26%; HR = 0.73; 95% CI, 0.65-0.81; NNT = 14) but not in the primary prevention group vs the placebo group (12% vs 14%; HR = 0.88; 95% CI, 0.70-1.1).
In the entire population, all individual outcomes in the composite were significantly fewer in the icosapent ethyl group (cardiovascular death: HR = 0.8; 95% CI, 0.66-0.98; fatal or nonfatal MI: HR = 0.69; 95% CI, 0.58-0.81; revascularization: HR = 0.65; 95% CI, 0.55-0.78; unstable angina: HR = 0.68; 95% CI, 0.53-0.87; and fatal or nonfatal stroke: HR = 0.72; 95% CI, 0.55-0.93). All-cause mortality did not differ between groups (HR = 0.87; 95% CI, 0.74-1.02).
No significant differences in adverse events leading to discontinuation of the drug were reported between groups. Atrial fibrillation occurred more frequently in the icosapent ethyl group (5.3% vs 3.9%), but anemia (4.7% vs 5.8%) and gastrointestinal adverse events (33% vs 35%) were less common.
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