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Icosapent Ethyl for the Prevention of Cardiovascular Events

Prof Nordestgaard said that genetic studies have shown that elevated triglyceride-rich lipoproteins can lead to atherosclerosis and inflammation, which can lead to myocardial infarction (MI). Genetic studies have also shown that lower triglyceride levels are associated with lower cardiovascular risk. Dr Bhatt then said that although low-dose omega-3 fatty acids (1 g/day) are ineffective for preventing heart disease, higher doses (1.8 g/day) have been shown to reduce coronary plaque and the risk of coronary events. He then described the recently published REDUCE-IT trial, which randomised ~8,000 statin-treated patients with elevated triglycerides (1.52–5.63 mmol/L) to icosapent ethyl 4 g/day or placebo. Those randomised to icosapent ethyl had significant reductions in triglyceride levels and cardiovascular events. American and European guidelines have now recognised that omega-3 fatty acids 4 g/day can be beneficial for the management of hypertriglyceridaemia and that icosapent ethyl, in particular, lowers the rate of cardiovascular outcomes. Dr Gitt presented data showing how many patients from DYSIS, a cross-sectional, observational study of lipid goal achievement among statin-treated patients, could benefit from icosapent ethyl. Among >60,000 patients in DYSIS, 72% were at very high cardiovascular risk, and 48% of these had triglycerides >1.52 mmol/L and could therefore potentially benefit from icosapent ethyl. Finally, Dr Konishi presented imaging data showing that eicosapentaenoic acid (EPA), of which icosapent ethyl is a purified ester, is associated with decreased plaque instability. This could help to explain how icosapent ethyl reduces cardiovascular risk.