Icosapent ethyl reduces whole-heart coronary atherosclerotic plaque burdenNews - May 31, 2021
Effect Of Icosapent Ethyl On Percent Atheroma Volume In Patients With Elevated Triglycerides On Statin Therapy – Insights From The Evaporate Trial
Presented at ACC.21 by Suvasini Lakshmanan, MD (Torrance, CA, USA)
Introduction and methods
The REDUCE-IT trial demonstrated a significant reduction in the primary composite endpoint CV death, MI, coronary revascularization, or unstable angina and key secondary composite outcome in statin-treated patients who daily received 4 g of icosapent ethyl (IPE). However, the exact mechanism for the observed CV benefit by IPE remains unknown.
The EVAPORATE trial was a randomized, double-blind, placebo-controlled study to examine the effect of IPE on progression of coronary atherosclerosis, assessed by cardiac computed tomography angiography (CTA). Patients (30-85 years) with elevated TG levels (135-499 mg/dL), LDL-c levels between >40 mg/dL and ≤115 mg/dL (on maximally tolerated statin), and ≥1 angiographic stenosis with ≥20% narrowing measured by coronary CTA were included. Exclusion criteria were: a history of coronary artery bypass grafting, MI, stroke, or life-threatening arrhythmia within the prior 6 months. Patients were randomized to IPE 4 g/day or placebo (mineral oil).
The aim of this subanalysis of the EVAPORATE study (n=68) was to assess the effect of IPE on whole-heart coronary atherosclerotic burden by analyzing the change in percent atheroma volume (PAV) over 18 months using serial coronary CTA. PAV was calculated as the proportion of total vessel wall volume occupied by atherosclerotic plaque. PAV can be used to quantify whole-heart coronary atherosclerotic burden as it allows for normalization of coronary vessel volumes.
- Patients with IPE treatment had a 55% reduction in total PAV compared to those with placebo (P=0.006).
Statin treated patients who received 4g of IPE per day demonstrated after 18 months a significant reduction in whole-heart coronary plaque burden compared to patients with placebo. The findings of this subanalysis suggest that the clinical benefits of IPE observed in the REDUCE-IT trial are mediated by reduction of whole-heart atherosclerotic plaque burden.
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