Physicians' Academy for Cardiovascular Education

Icosapent ethyl reduces coronary revascularization in patients with high CV risk and elevated TG

Reduction in Revascularization with Icosapent Ethyl: Insights from REDUCE-IT REVASC.

Literature - Peterson BE, Bhatt DL, Steg PG, et al. - Circulation 2020 Nov 5. doi: 10.1161/CIRCULATIONAHA.120.050276.

Introduction and methods

Patients with hypertriglyceridemia while receiving statin treatment, have an increased risks of ischemic events, including coronary revascularization. Plus, elevated triglycerides (TG) levels are thought to play a role in the development and progression of coronary plaque and vessel inflammation contributing to residual coronary atherosclerosis [1-7]. However, previous clinical trials with TG-lowering agents, including omega-3 fatty acids, fibrates and niacin, have not demonstrated a consistent reduction in coronary revascularization events [8-12].

Previous analyses of the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) have shown that icosapent ethyl reduced the occurrence of major cardiovascular events [13,14]. This study further assessed the effect of icosapent ethyl, compared to placebo, on coronary revascularization in participants of the REDUCE-IT, by evaluating all first coronary revascularization events, which included preoperative conditions and surgical procedure types.

The REDUCE-IT trial was a multicenter, double-blind, placebo-controlled, randomized trial with statin treated patients (≥50 years) with CVD, or diabetes with at least one additional CV risk factor, all with persistent elevated triglyceride levels (≥135 mg/dL and ≤500 mg/dL) and well-controlled LDL-c levels between 41 mg/dL and 100 mg/dL. Patients were randomized (1:1) to 4 gram icosapent ethyl daily or matching placebo. For this analysis, the primary endpoint was first coronary revascularization events, including the preoperative revascularization conditions (elective, urgent, emergent, or salvage) as well as categories of surgical procedures (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]). These revascularization endpoints were reviewed by blinded adjudicators. Median follow-up was 4.9 years.

Main results


In this subanalysis of the REDUCE-IT trial, icosapent ethyl additionally given to statins in high risk CV patients with persistent elevated TG levels reduced the risk for first and subsequent revascularization. This effect was consistent among different preoperative revascularization conditions, and PCI and CABG procedures.


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